“Let’s abandon our broken NHS and move on”, says Melanie Phillips.
Dame Julie Moore, the respected chief executive of the University Hospitals Birmingham trust, was asked last week to explain why the NHS was in such difficulty. A lot of it, she believed was down to leadership failure and incompetence on every level. “We’ve created a culture of people who are terrified of making decisions because you can’t be held to account for making no decision but you can if you make a decision,” she said.
Much of the blame lay with previous governments who had centralised power, leaving many of her colleagues “waiting for a command from God on high” instead of taking the initiative.
What Dame Julie describes is typical of highly politicised bureaucracies. In the NHS, this entails a culture of fear from the health secretary downwards. What are they all so frightened of? In essence, that the veils of illusion surrounding the NHS will be torn away and it will be seen to be the failure that it is.
That this is so surprises me not at all. That it is said by a popular, if marmite-flavoured columnist suprises me a little. That the comments ordered by recommendations enthusiastically agree with her surprises me quite a lot. One would get a very different result at the Guardian, of course. The Daily Mail? Right now, I think the Mail readers would feel as free as Times readers do to recount their bad experiences of the NHS, yet would still baulk at the words “abandon the NHS”.
Wait, you’re saying UK bureaucrats can be held to account for the decisions they make?? Wow. I think that’s something you have over us across the pond….
Judging by the humber of doctors who have had their careers ruined for “whistleblowing”, which in a sane organisation would be called “expressing their considered professional judgment”, then the NHS hierarchy is more akin to the Stasi than anything else. The whole organisation has jumped the shark.
Like all bureaucracies, and this one is just about the biggest in the world, the main objective of its managers is to secure the survival of the organisation, not the delivery of its service.
I’ve always said the NHS will finally die when enough of the population have experienced its ‘delights’ such that when a politician has the bravery to stick his or her head above the parapet on the issue, the media are amazed to discover that they are tapping into a deep vein of public opinion that agrees with them. Suddenly it will be acceptable to demand reform of the NHS, and many more will follow. In fact it could all unravel very quickly.
I personally don’t know anyone who has a good word to say for the NHS, particularly the GP service (I say service, in reality its a money making system for GPs that occasionally happens to do some healthcare on the side). Everyone has horror stories to swap.
Public support for the NHS is a shell. Its massive and formidable on the outside, shored up by the shock troops of the unions who use shock and awe on anyone who dares to threaten their meal tickets, but the public are melting away from the core. Its just waiting for one key element to be removed and the whole will collapse in a heap.
Someone of my acquaintance was ill on holiday in Turkey recently, and was amazed to find that before prescribing an antibiotic for the infection, the GP took a swab so as to identify the bacterial species responsible and to find the optimal antibiotic to combat the infection. I and they had never known that happen with a GP on the NHS.
I’ve heard that in some countries they even keep hospitals clean.
I have long thought that the NHS was the religion of the British.
However, perhaps I am mistaken – perhaps people are having doubts about the system.
“the GP took a swab so as to identify the bacterial species responsible”
In the NHS, they would have to send the sample “away to the lab” for analysis, which would take “about three weeks” (everything takes “about three weeks”), by which time the infection would have gone away by itself, so there’d be no point. But nobody will leave the GP surgery without a prescription for some pills, so they just hand them out anyway. It avoids complaints, after all.
In another life, I once had to take a sick baby to an American paediatric practice; the doctor took a blood sample, and handed it to an underling; about five minutes later she came back with the results. And in case you’re wondering, the bill – inlcuding everything – was about $160 (in 1982). Different world.
Pithy political question from a colonial ignoramus here. Is marmite anything like vegemite? And should I fear it accordingly?
marmite v vegemite,
Anyone in the UK who remembers pop music in 1983 (a very good year) should instantly recall Men at Work and their song Down Under and the line ‘ He just smiled and gave me a vegemite sandwich‘ which AFAIR did more for brand awareness than any amount if advertising and generated endless comments from DJs about Vegemite and Marmite.
The consensus seemed to have been that the two were essentially the same nîche, but Vegemite is adapted to the local conditions, a bit like the kangaroos vs sheep and cattle.
I know quite a few, mainly people with cancer. This is because the NHS can be exceptionally good. The problem is not that the NHS is never good, it is that when it is shite it is particularly shite and shite in a very cruel and callous way*, and nothing can be done about it. The other problem is that whereas the NHS is pretty good at saving the your life (yeah, I know that funny quote from one of the global health services, but A&E and other ICU treatments are still good) vast swathes of healthcare are about improving quality of life and not saving it. The NHS is shite at this.
*For example, parking in hospitals must be paid for. No problem with that, but the charges are high. Again, no problem with that in itself, but the machines sometimes only takes coins: they’ve not bothered installing ones which take cards. So unless you have £50 of coins knocking around when you suddenly find yourself having to rush a relative to the hospital, it’s tough shit.
JohnK said,
“Like all bureaucracies, and this one is just about the biggest in the world, the main objective of its managers is to secure the survival of the organisation, not the delivery of its service.”
I don’t know about UK medical service, but I have no doubt that the above statement is true. Everything “socialized” is damned to become substandard. The more they try to save money, the more they’ll bleed cash on all the wrong places. Finally, like with American public schools, record amounts of money will be poured into it, and the ostensible desired result (kids learning in the case of schools) will be the least of the bosses concerns.
It’s gotta be said, socialism is for fucking idiots.
Ah, but there are many bright socialists. The problem has been phrased as “politics is the mindkiller,” which is another way of saying that emotions/values are in charge, not logic and evidence. See Jonathan Haidt on this.
“We’ve created a culture of people who are terrified of making decisions because you can’t be held to account for making no decision but you can if you make a decision,” she said.
O poor us. Inward looking: that is precisely the problem.
“We” have created a culture of people who are NOT terrified of doing anything or indeed doing nothing because they are not accountable to the people for whom they and their jobs allegedly exist… the consumer of their output (patients as some insist on calling them so they can pretend healthcare is not a business like everything else with a producer and a consumer.)
The NHS lacks the free market disciplines of repeat business (NHS does not want repeat business because it uses up budget), good reputation to gain new business (NHS does not want new business because it uses up budget and the people in it get no more reward for doing more), bankruptcy if the business does not meet consumer requirements (the NHS can never go bankrupt because the taxpayer always will have to bail out this World Class Stalin-era State Collective).