THE LAST DITCH An Englishman returned after twenty years abroad blogs about liberty in Britain
Anna Raccoon's story continues...
The moral limits of incentives?

All organisations funded by force are immoral - Part 2: the NHS

The lethal medical arrogance behind the Liverpool Care Pathway | Melanie Phillips.

Melanie Phillips, not my favourite journalist, has been writing about the "Liverpool Care Pathway." Something Goebbelish about the name of this route to death is enough to make decent people suspicious, but that's modern Britain for you; all marketing mouth and no trousers.

My point is not about the "pathway" itself, but the response from the medical profession to Phillips' criticism of how it is sometimes misused. The arrogance is disturbing but unsurprising. During 20 years of living abroad, Mrs P and I had occasion to use the services of doctors from time to time. We were always pleasantly struck by the difference in their approach to that of their colleagues in Britain. They did not give "orders", they discussed our issues. They looked at us while they did so. They gave us time and treated us with respect. They did not dish out government propaganda and were not subject to government incentive schemes to adopt particular approaches. In short, they treated us like I treated my clients.

At the French-run Moscow clinic we used for a while, an NHS trained doctor came to work. She lasted a few weeks before being dismissed at the request of patients. She treated patients as so much meat, did not give them time or listen properly to what they had to say. Worst of all (and inexplicable to patients with no experience of Britain's Soviet-style healthcare) she reached for some kind of NHS manual for guidance as to approved treatment. Her patients expected more than that. They wanted to see the exercise of intelligent, professional judgement based on reasoned discussion. They didn't want judgements handed down from Mount Olympus by a self-appointed god. 

The NHS is a state monopoly enterprise. As such things will, it has steadily morphed into a worker's co-operative. The interests of staff take precedence over those of the customers-with-no-choice and the attitude to said customers tends to the dismissive. That's inevitable, because of the moral darkness at its heart; it is funded by force. The good opinion of patients is therefore not required. Promotion within the organisation depends upon contribution to its own goals, not those of the sick people it exists to serve. They are indeed routinely and insultingly described by NHS aparatchiks as a "cost" to the NHS, though they - collectively - pay for it.

There's nothing wrong with these medics that would not be fixed by exposure to competition and the humility it brings. You may say that they already have competition from the private health care industry but that's not really true. The doctors in private hospitals are overwhelmingly NHS consultants earning a bit on the side. Their primary source of income - and pension - is the state monopoly. They are with few exceptions trained by that monopoly and imbued with its stale ethic. If the system were fully private, they would have to provide A&E services, but instead they just offer a luxury add-on. I am fully privately-insured, but if I have an accident I will end up in the NHS's tender care. There is no way out of that in Britain.

It is indeed "our NHS" as the Tories feebly insist. I wish it bloody wasn't.