The NHS: decline and fall?

I’ve worked in the NHS for 32 years, man and boy, so to speak.

I don’t do private work, though I don’t have an issue with it ideologically.

I admire Bevan and Beveridge who kicked off the whole enterprise in 1948, although I’m pretty sure that they’d be horrified by what much of the NHS and the associated welfare state has become.

We do seem however, to be approaching an NHS End of Days scenario, by which I do not mean the ludicrous cry of “they’re privatising the NHS”. ‘They’, generally speaking, are not capable of such sophisticated thinking, and ‘they’ are unable to tame the behemoth of NHS spending. It’s probably not possible under the current provision. The answer is not more money.

It’s always interesting to gauge what outside healthcare providers think of the NHS. When I get tourists and similar in as emergencies, they often can’t believe that all this is ‘free’. It isn’t of course, if you pay tax, but you know what they mean. The unappealing spectacle of billing and insurance checks is absent from our clinical areas. But what seemed free, high quality and good value, has been overtaken by hangers on, from the shop floor to the upper tier of government. Everyone wants a slice of the pies – both the goodwill and ‘nobility’ associated with providing healthcare, and also the financial rewards*** embedded within its now enormous bureaucracy.

Here is Ted Noel, a retired US anaesthetist, musing on the problem:

Bevan succeeded, but his victory is being erased by the Law of Subsidy**. What was sold as a boon to the poor has become a subsidy for bureaucrats. The Law of the Bureaucrat declares that while a bureaucracy may have been created to deal with a perceived problem, the bureaucrat’s Prime Directive is to ensure that he has a job forever. And because he was appointed to solve the problem, he’s smarter than everyone else and should be paid accordingly.

Perversely, the bureaucrat can never solve the problem, or his job would disappear. So he continues with the language that created him, trying to sell greater and greater funding for his failed enterprise. And when it fails more dramatically, he blames anyone but himself, and gets rewarded with a bigger budget. Ultimately, as Margaret Thatcher famously quipped, “The problem with liberalism is that eventually you run out of other people’s money.”

The Law of Subsidy has killed the NHS. It just doesn’t realize that it is dead. But thousands of those it was created to care for are dead, because it simply cannot fulfill its promised goals.

He may be right.

…good times

 

**The Law of Subsidy says that “When you subsidise something, you get more of it and it gets more expensive.”

*** subsequent to this blog post, here’s a nice confirmatory piece from the estimable Max Pemberton