The Last Ditch

Proud of the NHS?

The Conservative Party | News | The Blue Blog | We are proud of the NHS.

David Cameron sent me an email today. Click the link above to read it in full. He wrote;

One of the wonderful things about living in this country is that the moment you're injured or fall ill - no matter who you are, where you are from, or how much money you've got - you know that the NHS will look after you.

Why does the leader of the Conservative Party praise the world's largest socialist institution? Why did he denounce Conservative MEP Dan Hannan for the interview he gave on Fox News recently? If Conservatives really believe the NHS is an efficient way to organise the provision of healthcare, why do they not advocate the same system for the provision of food, transport or housing?

Look for the #welovethenhs "hashtag" on Twitter, and you will enter an alternate universe of sentimentality and denial. If a single state provider of healthcare from general taxation were the only alternative to the American system,  the NHS would not be the second largest employer in the world. Not only is it not the best alternative to the American system, it is not even a better one. If it were, cancer survival rates in Britain would be better than in America, not worse.

Why won't the British open their eyes? Why won't they compare their system with those of healthier countries? Why is support for the NHS so widespread? Why are politicians of the right so in favour of it?

In truth, they are probably not. The employees of the second largest organisation on Earth are too big a bloc vote to take on. Labour has engineered a political deadlock, which only it can break. At one point it looked like Tony Blair might have the nerve to do it, but Gordon Brown prevented him. So we continue with the worst of all possible models for universal healthcare.

As Dr. Eamonn Butler, Director of the Adam Smith Institute, said;

If a privatised health service had made many of its patients wait for 18 months for their operations, put them on trolleys in corridors when they arrived, given more than a quarter of them an illness which they did not have when they arrived, and confiscated the organs of their dead babies without bothering to seek their permission, or even to tell them, people would have blamed privatisation. For that matter if one of its practitioners had murdered 150 of his patients, or one of its surgeons had removed healthy kidneys instead of diseased ones, or one of its teams had conducted smear tests so incompetently that operable disease was not treated, while healthy women were unnecessarily subjected to distressing operations, all this would somehow have been put down to the reckless pursuit of profit, or to putting shareholders ahead of patients

Dan Hannan is right. Americans would be mad to base their system on anything that resembled the NHS. They don't need to create a producer collective to ensure healthcare for all. A better system would involve no state hospitals or public-employee doctors or nurses. Provision of healthcare would be private from the hospitals to the local general practitioners. There would be a compulsory system of private insurance from qualified, competing companies. Policies would be provided under a regulated system which prohibited, for example, exclusions for pre-existing illnesses or differential premiums based on age. They would simply have to price their premiums accordingly. The government's only role would be to provide, from taxation, the means to pay the premiums of those too poor to pay. This is essentially the system in France and many other countries in the civilized world which enjoy better health than Britain or America.

If we changed there would be problems, but not the ones we fear. Our medical professionals have been entirely trained in the NHS for 60 years. They are generally not of the calibre needed to run a private system. Businesslike people in Britain currently don't choose to go into medicine. The few who train in the NHS without realising its nature from the outset, tend to leave the country when their training is done. It would take time for the culture to change. New generations of doctors would be more like other professionals; not just technically competent, but capable (as their distant predecessors were) of running a business. Those who didn't make that grade would be employed, as is right and proper, by those who did. Just like the less worldly or energetic lawyers, surveyors or engineers.

There would be transition problems. Socialists would point the finger and say it proved the NHS was right. But steadily things would improve. Fewer people would die prematurely. Patients would be treated with respect. Standards of health would rise. Cancer survival rates would pass those in the United States.

No, I certainly don't love the NHS. Neither should you.

More categories of lawful killing?

Commentary: The Case Against Physician-Assisted Suicide: For the Right to End-of-Life Care - Psychiatric Times

My post last Thursday on the emotive issue of "assisted suicide" predictably attracted many comments. One of my readers forwarded me a piece by Gerald Warner from the Daily Telegraph "blog" section. One of the comments to that, rather intemperate, post referred to a 2004 article from The Psychiatric Times about the Netherlands' experience with euthanasia/assisted suicide. It highlighted an aspect I had not previously considered;

"Euthanasia, intended originally for the exceptional case, became an accepted way of dealing with serious or terminal illness in the Netherlands. In the process, palliative care became one of the casualties, while hospice care has lagged behind that of other countries. In testimony given before the British House of Lords, Zbigniew Zylicz, one of the few palliative care experts in the Netherlands, attributed Dutch deficiencies in palliative care to the easier alternative of euthanasia."

It is the unspoken, because unpalatable, truth that in a socialised medical system the authorities have no choice but to prioritise patient groups. If the market doesn't allocate resources, they must be rationed. There is no "third way". The law of unintended consequences has, it seems, reduced the availability of palliative care. If Dr Zylicz's evidence is true, the medical authorities have, to be blunt, found euthanasia/assisted suicide a cheaper, more efficient alternative

And Guardianistas tell us that markets are harsh and cruel?

Given that those "progressive" enthusiasts of euthanasia/assisted suicide are fond of selecting horrific cases to support their case, let me cite some horror stories from the same article;

An illustration of a case presented to me as requiring euthanasia without consent involved a Dutch nun who was dying painfully of cancer. Her physician felt her religion prevented her from agreeing to euthanasia so he felt both justified and compassionate in ending her life without telling her he was doing so. Practising assisted suicide and euthanasia appears to encourage physicians to think they know best who should live and who should die

This god in a white coat knew that euthanasia was a sin, in this woman's eyes. So he murdered her to spare her conscience. Where does that leave his?

a patient with disseminated breast cancer who had rejected the possibility of euthanasia had her life ended because, in the physician's words: "It could have taken another week before she died. I just needed this bed."

Another "compassionate" and "progressive" professional in pursuit of "dignity" for his patients? No. A murderer, even under Netherlands law.

A wife, who no longer wished to care for her sick, elderly husband, gave him a choice between euthanasia and admission to a home for the chronically ill. The man, afraid of being left to the mercy of strangers in an unfamiliar place, chose to have his life ended; the doctor although aware of the coercion, ended the man's life.

I believe in freedom to choose, but choice under duress is not real choice. Correctly analysed, this poor man was murdered for his loving wife's convenience.

A healthy 50-year-old woman, who lost her son recently to cancer, refused treatment for her depression and said she would accept only help in dying. Her psychiatrist assisted in her suicide within four months of her son's death. He told me he had seen her for a number of sessions when she told him that if he did not help her she would kill herself without him. At that point, he did. He seemed on the one hand to be succumbing to emotional blackmail and on the other to be ignoring the fact that even without treatment, experience has shown that time alone was likely to have affected her wish to die.

How many of us would feel suicidal if we lost a child? The only thing more natural is, through grieving and the support of family and friends, to come back to life treasuring fond memories of the loved one lost. The psychiatrist could have turned her ultimatum back on her and said "no euthanasia unless you try therapy first", but perhaps it was easier to submit. This poor, sad woman could have lived a rich life for 30-40 years, but he executed her. Is that what people go into medicine to do? Can no-one else see the difference between her killing herself and that?

None of these killers will be brought to justice because the Netherlands government, to investigate the matter properly after complaints, offered immunity to all who spoke frankly. I am glad it did, because in exposing the consequences of the Netherlands' "progressive" law, these murderers may save lives elsewhere.

I have been accused of taking a non-libertarian position on this issue. I don't agree, but if I am wrong, so be it. I don't adopt a political position as an ideological game. I am not trying to belong to a tribe. I support libertarian policies because I believe they would lead to a better, richer, happier, more fulfilling society with greater opportunity for a greater number of people than the present statist shambles. If I were required to approve of such horrors to be a "pure" libertarian, then I would say to hell with it.

You can find truth in statistics (if you dig deeply enough)

Regular readers know what a fan I am of TED talks. The site is one of the best educational resources on the internet. This talk from 2006 is a perfect example. Hans Rosling, after working for years as a doctor in Africa, now lectures on "global health" at one of Sweden's leading universities. He uses graphics to show statistical trends in the most powerful way, exploding myths as he does so. For me the best moment is when he explodes the large bubble representing Africa into its component parts, showing the huge difference between Sierra Leone at the poor extreme and Mauritius at the rich, healthy extreme (having negotiated international agreements that allowed it to trade more freely). Watch the whole thing. His enthusiasm is so impressive and I guarantee you will have a pre-conception shattered.

...and for your further delectation, here is the sequel from the following year (with a surprise ending)

Addiction to internet 'is an illness'

Link: Addiction to internet 'is an illness' | Technology | The Observer.

Are scholars addicted to their libraries? Artists to their brushes? Writers to their pens? Of course not. Show me a successful person, and I will show you someone Dr Jerald Block would consider "obsessive". The world is shaped by such people, with the "balanced" - largely idle - masses passively accepting the benefits. Without such "obsessives", Dr Block would be practising his dark art in a cave.

Characterising behaviours as "addiction" is a dangerous thing to do. It infantilises people by portraying their free choices as illnesses. It excuses those who wish to modify others' behaviours by portraying their tyrannical impulse as compassion. Often it seems that psychiatrists are the natural medical allies of political authoriarians. As Dr Crippen recently reminded us, it was only in 1954 that the American Psychiatric Association stopped characterising homosexuality as a mental disorder. And the psychiatrists of the Soviet Union did not notably dignify their calling either.

Personally I think any young person who wants to practise psychiatry should consider therapy.

Leaving medicine

Link: NHS Blog Doctor: Leaving medicine.

Socialists will tell you that "boom and bust" is a capitalist phenomenon, but if you want real "feast or famine" try central planning. After sucking in foreign doctors for years, the UK's central planners girded up their loins and achieved a surplus of trained doctors. Over at NHS Blog Doctor (compulsory reading for anyone with the slightest interest in health care) newly-qualified doctors are complaining about having to leave their profession. Why? Because they cannot get jobs in Britain's system of socialised medicine. They have a qualification that families in other countries would spend many tens of thousands to acquire for their offspring and they are throwing it away.

On the other hand, whether or not you or your health insurer can afford to pay for private treatment, you almost certainly can't find a private General Practitioner (GP) in the UK outside London. Your health insurance (or wealth) can buy you private hospital treatment, but - as consultants insist on a referral - you must first go to your local Soviet Polyclinic health centre and see a State-funded GP.

These unemployed new doctors blistered their brains studying to qualify in a demanding profession. Outside Soviet Britain, it is perhaps the most respected and valued profession of all. If they don't want to cash in on their investment by emigrating, why don't they just "hang a shingle" and offer private services? It can be done.  Here's an example turned up by thirty seconds of googling.

One of many reasons I never expect to return to the UK is that - after experiencing excellent care from polite and courteous private doctors abroad - I could not face standing in line with bored pensioners filling their days, malingerers looking to be signed off work and others that I would cheerfully pay good money to avoid. All this, just to get five minutes with a GP who would probably not look up from his desk. Yet starting a private service to sell their hard-earned skills for profit simply does not occur to these bright young people.

They are gifted, intelligent and well-placed to serve their fellow man. Their potential for a satisfying, rewarding career is enormous. Yet they feel impotent in the face of state incompetence and bleat like unemployed dockers. Yes it's difficult to compete with "free" services. Yes most people will stand in line rather than pay. But in business you don't need everyone to be your customer; just enough people. A substantial minority would pay a premium for time, attention and courtesy. Why does that not occur to these talented, presumably highly-intelligent individuals?

The problem may be that in choosing medicine in the first place, they had already ruled out a life in business. Their most likely career path was into the socialised health service, so presumably that (to me) grim prospect was appealing? Perhaps they see themselves  as "caring" types and are snooty about "money-grubbing." Perhaps, in short, like so many in Britain, their spirits have been neutered by Socialist indoctrination.

It's such little things that tell you our civilisation is close to its end.

Welcome back, Dr Crippen

Link: NHS Blog Doctor: A Fresh Start.

The NHS Blog Doctor, who was so much missed during his blog break that rumours of his death circulated, is back. Welcome, sir. He's off to a fine fresh start with the linked post:

Last Saturday, we had a re-union dinner of a group of doctors who have kept in touch since medical school. Some GPs, some consultants, and even a well known medical politician. You would have heard of him. All long-standing friends and all, over the last two years, a constant source of inside-track information. They have been missing their opportunity to vent their spleen through Dr Crippen.

And then, one of those wine-induced dinner-party epiphanies. The Paediatric Professor ... said,

    “You know, if I were suddenly taken ill, I would be terrified to be admitted to a British NHS Hospital.”

We went round the table. Each and every one of the ten doctors present felt the same.

It is time to start again.

Hear hear. Britain's Soviet healthcare system is a national disgrace. Which politician will have the nerve to say so though?

Hospital deaths scandal

Link: BBC NEWS | Health | Hospital bug deaths 'scandalous'.

I am glad I didn't blog immediately about this. The reactions are more interesting than the story itself. That NHS hospitals are filthy is no surprise to any Briton. The NHS is one of the three largest employers on Earth (with the Peoples' Liberation Army and Indian Railways). If we don't work there ourselves, we all know someone who does. If we have not been treated there ourselves, we have visited a friend or relative in hospital.

Reactions to the story are ridiculous, whether from "left" or  "right." Those for whom the NHS is the Holy Grail of the True Faith spin this as a failure of local management, and demand firm reprisals and a purge. The errant comrades must be firmly punished for their betrayal of the Service's Socialist values. They react , in short, exactly as the Chinese Communist Party does to the occasional token corruption case; (a) make an example of a "class traitor" to confirm the purity of the system; and (b) continue to lead the same life as the disgraced former comrade.

As Guthrum laments, there is no real understanding of liberty in modern Britain. The so-called "right" are merely another pack of Statists on a slightly different "make," aching to pull the levers of the same huge, inefficient machine. Therefore they too demand that heads should roll. As they are out of office, they are prepared to call for them to roll in the responsible Ministry as well as in the local organisation.

In calling for punishment of errant bureaucrats, both "left" and "right" are telling a more profound truth than they know. Any centrally-planned mechanism for the delivery of anything, whether it be missiles to our enemies or socialised health-care to our masses, must depend on command, control and discipline. The 20th Century taught us that this is the only alternative to markets. There is a reason why "command economies" earned that name.

Where patients choose their doctors and (on professional advice) their hospitals, health-care facilities depend on satisfied patients to provide livelihoods to those who work in them. The "cruel, harsh market" will effortlessly ensure that each hospital is clean, because otherwise no patient will choose it. Nor will any family doctor risk a negligence claim for referring a patient to it. Adam Smith's invisible hand will take lazy cleaners by the ear and guide their labours. Managers will be steered by the same invisible hand because they will be directly accountable to shareholders who will suffer personal losses if the hospital is sued (as opposed to Ministers who can pay the damages from taxpayers' money). There is no need for extreme punishment to achieve simple outcomes. The market will apply millions of invisible sticks and carrots, second by relentless second.

Clearly, if even Dr De'Ath over at  the usually libertarian Devil's Kitchen blog (sigh) believes that "privatisation" is part of the problem, many of us doubt this. From the comments at the BBC website, one would believe that if the cleaners were State employees (as opposed to merely being under contract to the same) all would be well. What tosh.

The token gesture of "outsourcing" cleaning services has done nothing more than take thousands of State employees "off balance sheet". It is the employment equivalent of the Private Finance Initiative. The terms of the contracts are set and enforced by State apparatchiks. Managers who accept poor service from contractors would have accepted the same from employees. The nurses who told patients to soil their beds because they were "too busy" to bring bedpans were direct employees, were they not? Q.E.D.

The reactions to the story show that nothing has been learned. If you believe in the NHS and you are on the "left", you will think that higher taxes and more aggressive "command and control" are required. If you believe in the NHS and you are on the "right," you will think the latter will suffice. If you don't believe in the NHS in the face of all the evidence against it,  you are probably neither British nor Michael Moore and must by now be completely mystified.

So who did write the "brilliant" letter?

From the Daily Telegraph online letters page:

"Correction: In yesterday's paper, we published a letter purporting to come from Mike Hallissey, a consultant surgeon in Birmingham. In fact, the letter was not written by Mr Hallissey and did not reflect his views. We apologise unreservedly for the embarrassment this will have caused."

So who was the brilliant joker then, who took such elegant revenge on Mr Hallissey? Why revenge? Well, as "Chair" of the West Midlands Basic Surgical Training Committee, he may have been instrumental in creating the current MMC ("Modernising Medical Careers," better known to young doctors as "Massive Medical Cull") farce. Or then he may just have rejected some bright young doctor with a sense of humour.

Either way, I think we should be told - even if there are 8,000 suspects.

Brilliant letter from Mr Mike Hallissey?

Link: NHS Blog Doctor: Brilliant letter from Mr Mike Hallissey.

It tells you everything you need to know about today's NHS that people cannot decide if the letter referred to in this post by Dr. John Crippen over at NHS Blog Doctor is (a) for real, (b) a brilliant spoof by Mr Hallissey, or (c) an act of revenge by a junior doctor.

The letter, published in the Daily Telegraph, contains the following magnificent sentence:

"Experience and academic ability are elitist principles which the Government has worked hard to nullify."

Yet members of the medical profession cannot decide if it is (a), (b) or (c). Read the comments over at the original post. This is fascinating!

The women who went through an ordeal beyond belief | the Daily Mail

Link: The women who went through an ordeal beyond belief | the Daily Mail.

Time and time again, idiots proclaim "something must be done" and "what about the children" before casting off freedom and justice and embarking on State-sponsored witch hunts. The Daily Mail describes the ordeal endured by the children and parents of Cleveland 20 years ago as "beyond belief." They could not be more wrong. Anyone on the receiving end of the British State's "caring" attentions will recognise the sensations of horror, disgust and impotence described by the Cleveland families.

Only the most naieve could expect that, when the State apparatus intervenes in family life, it will be any more competent or kind than when it does anything else. I know a respectable, loving, middle-class family whose children were taken from them (briefly) after false accusations of abuse. The glee of the social workers at being able to persecute their class enemies was almost palpable. For the parents, smug and prosperous New Labourites, I have no sympathy. They needed to experience the realities of State power as endured by so many at their hands. I do feel sorry for their children.

I would be surprised if one of the Cleveland children is, as the article suggests, brave enough to pursue the matter. It is too delicate even for British afternoon TV. The publicity would harm her life, that of her family, and the lives of all the families. It would, ultimately, be a waste of time. The true "caring" attitude of the British State is revealed by the fact that Dr. Marietta Higgs is still working as a paediatrician in the National Health Service.

So many foolishly look to the State for protection as if it were any more perfect than any human agency. If you are in trouble, look to your family or friends. Throw yourself on the mercy of a stranger if you must. Your chances will be better. The British State only looks after its own.