N.H.Yes?

I’ve started and abandoned a dozen blogs since the last I posted and simply not had the time to ride those thought buses to the terminus. It’s happening more and more just lately as deadlines for real work appear on the distant horizon then suddenly loom large before disappearing in the rear view mirror; forgotten ticked-off events that mark my passage towards my own ultimate deadline. This might sound a tad morbid and forlorn but it’s natural to wonder about how we prepare to meet the end.

Oh, I’m sure I have a couple of active decades left in me yet, but how active and more importantly, with what level of agency? Given the parlous state of, well, everything, will there be enough left in the pot – both mine and the state’s – to facilitate a dignified descent into comfortable docility, or will there simply be no pot left to even piss in? Even the most optimistic of us, even the luckiest, must surely entertain dark thoughts, on occasion, about what might lay ahead.

All of which is why, whether we believe in it or not, whether we worship at its altar or avoid it altogether, we really should be concerned about the state of the National Health Service. Once a ground-breaking and quite possibly world-beating system of keeping the labour force healthy and productive it has become a deified monolith of gargantuan proportions. It employs a ridiculous number of people – yet there are daily calls for more – and it consumes a huge amount of ever-more-thinly stretched national resources. And as its customer base expands exponentially this is a situation which can only worsen.

Those who paid for it all – the elderly who now rely on it and who also need social care, now that society has abrogated responsibility to government for every aspect of its wellbeing – are unsurprisingly disdainful of how its largesse is extended to all comers. The free-at-the-point-of-use model is no longer viable as fewer and fewer people now actually contribute to its funding, yet more and more funding is demanded. The whole thing is on a one-way journey to collapse unless something new happens.

The decades-long row between Conservatives and Labour over this supposed national treasure isn’t good enough. Labour must not be allowed to get away with demanding ever more money yet having no realistic method by which to raise it. And the Conservatives must stop throwing £billions into its gaping maw while kicking the can of unpopular reform further down the road to ruin; nobody is listening when they insist that they have spent more than Labour ever did, because all they see is their grandmother waiting months in agony for a hip replacement.

The Tories have got to stop trying to appear reasonable; they lost the insincere battle for popularity far too long ago. That is the Labour confidence trick and it’s wearing thin. We don’t need reasonable, we need backbone and a dose of effective medicine – a political emetic to vomit up the flux. Stop gingerly picking at the scab and prolonging the pain; steel yourself for the sting and rip the damned thing off. People will complain whatever is done, but until what is done is drastic and transformative, the only thing you will hear will be those complaints.

Nurse!

When a structure is crumbling, there is only so much you can do to shore it up. There comes a time when you need to cut your losses, tear it down and start over. The NHS is not a unique and inviolable, precious thing which cannot be touched. It is just another symptom of the loss of British backbone, identity and resolve. And part of that Britishness was not relying on others to fix our problems. We may have already lost the ability to deal with all this, but if we don’t heal ourselves, who else do we think is going to do it?

If it quacks?

Monday used to be National Sicknote Day, the day when your local GP would glance at the full surgery waiting room but know he would be out on house calls by mid-morning. The genuinely ill didn’t bother dragging themselves to the local practice because it would be standing room only until the cursory examinations were completed by the dispensation of a couple of aspirin and an illegible signature securing a few days off for the malingerers. By the early eighties, Self-certification for Statutory Sick Pay allowed the workshy to diagnose their own twenty-four hour stomach bugs and freed up the doc from providing social security to get back to medicine.

In other countries healthcare is less heavily abused, probably because costs are born by the sick or their insurers at the point of treatment. But in Britain, integral as it is to the welfare state, the NHS is yet another much-abused entitlement whose heaviest users are often its lowest contributors. If you build it they will come and at times a city-based A&E department can resemble the temporary, volunteer-manned mission hospital set up hastily in the aftermath of war and famine in a primitive, flyblown forgotten African state.

Whose job is healthcare really, though? Surely the care of you and yours ought to be very much yours and theirs. And while screening for less visible conditions and early treatment for some is undoubtedly vital, when you delegate all responsibility for your wellbeing to people whose time is necessarily rationed, is it any wonder that the system is regularly described as ‘creaking at the seams’, ‘in crisis’ or that we have a matter of days to ‘save’ the NHS.

The Academy of Medical Royal Colleges has recently identified a number of routine treatments and checks which may have little efficacy and has called for a change of culture in how doctors prescribe treatments. Just because your patients demand treatment it doesn’t mean they need it. The press doesn’t help here, nor does the chattering of the Internet. No sooner does a treatment become available than some people are in the queue for it whether it is genuinely applicable to them or not. If blood-letting were to be reintroduced it wouldn’t surprise me to see leech surgeries springing up in Portakabins hastily set up in hospital car parks.

The NHS was once described as ‘the envy of the world’, although doubts have always existed over whether that was ever actually true. But it has always struggled against the weight of demands for it to dispense quackery for free alongside genuinely life-saving treatment. It could be argued that the gullible demand for crackpot cures and old wives’ social psychology could be provided ‘in the community’ by private providers. To relieve the pressures on general practitioners maybe we should issue vouchers to be redeemed at the local witch doctor ?

You'll just feel a little prick...

But don’t we already do that by promoting the alternative therapy scene? Reiki, acupressure, naturopathy, aromatherapy, balneotherapy, homeopathy, biofeedback, reflexology... candles, crystals, stones and bones, consulting crones; when will we three meet again? And people willingly turn to these means when conventional medicine hasn’t helped; often because ailments are imaginary, or self-inflicted. Since the NHS was set up it has gradually dropped its universal offerings; eyes and teeth and ears have all gone to private providers; why not do the same for malingering too? Outsource imaginary ailments to the imaginary cures industry and let the sickbay rangers get the treatment they deserve. 

NHS Saving

Dateline 08^th May 2016

Well, one year on from David Cameron’s close victory over Labour, the SNP and the Greens who together tried to deny the will of the people and block the Queen’s speech and it looks as if Cameron’s ‘alleged’ decision to intervene and remove Alex Salmond’s political teeth has paid dividends. UK Plc is firmly back in business, the deficit is going down pretty much as planned and investment is pouring into the country as, one after one, the southern European countries follow Greece and leave the doomed Euro to the Germans and the French. Alex Salmond is still eating through a straw, but few now remain to object… or care.

One of the great triumphs of the Conservative minority government – with the backing of the remaining LibDem MPs (on whom sufficient blackmail material was gathered to ensure their cooperation) – has been the resurgence of the National Health Service. Despite all of the opposition’s best efforts to sabotage recovery and rabble-rouse the health workers’ unions into punitive action, the NHS has not only endured but triumphed under new management. Strikers have been summarily dismissed with the authority of new emergency powers granted to hospital administrators promoted entirely from the ranks.

The top-line managers who were displaced and objected about it have been taken out and shot and all nursing degrees have been annulled, returning nurses to front line service under recalled matrons. So far few complaints have been received and given that a punch in the mouth from a ward sister is a likely outcome for time wasters, the throughput on those wards has increased two-fold. There is a belief that people are too scared to be ill for very long and as a result, even though the economy is booming, the NHS is now treating more people, more effectively, for less money while still affording handsome pay rises to nursing staff, paramedics and the blokes that service the machines which go ‘beeeep’.

Who would have thought that a tired old format could be resurrected with such success? But resurrected it has been and with ex-Army Medical Corps staff training up the triage nurses the number of malingerers, hypochondriacs, violent drunks and psychotic drug abusers clogging up A&E departments has dwindled so far that security staff have been let go and police officers released to go back to catching criminals. Despite the charge of cronyism, David Cameron’s appointment of a personal friend to lead the new NHS has come in for little in the way of serious criticism, the results speaking for themselves.

This need not hurt a bit

Due to the no-nonsense approach and a ruthless cutting out of unnecessary services, treatment for imaginary ailments, alternative therapies and touchy-feely pastoral care, the NHS is playing a major part in getting people off the disability registers and back to work. They say it is an ill wind that blows nobody any good and the new boss has form with tired old formats. Under the stewardship of Jeremy Clarkson Britain once again has the finest health service… in the world. And on that bombshell…

Big is Butt Ugly

The theme of last night’s Newsnight seemed to be that whatever government is in power the NHS operates primarily for the benefit of its staff and not that of its patients. We’ve seen this before; the rail and coal and steel industries all suffered the fate of state monopolies with self-interest coming before efficiency and ever higher subsidy required to cover up the reality that economies of scale are simply lost when there is no real accountability.

As more and more scandal is reported and more and more evidence comes to light about a profession blighted by targets and box-ticking and the relentless imposition of qualifications in place of simple human compassion, the current government is lambasted for attempting the necessary reforms while the Labour Party seems to be more concerned than anything else with covering it all up and saving their own skins.

NHS; the emphasis should be on the H and not on the N – focusing on the so-called big picture and the sanctity of the state behemoth (one of the largest employers in the world) the detail has been neglected. And the detail is all about the patient care; the small print is written in human misery. Ah but, we are all stakeholders in nationalised industries surely and that must be a good thing, right? Except that is a just another meaningless sound bite, the product of governments unable to tackle reform on political grounds and trying to justify throwing ever more money – our money – into the pit. We must ‘save’ the NHS; the envy of the world, the jewel in the crown of the welfare state. Anything to put off the day when sleeves have to be rolled up and the rot eradicated.

It’s a mere aphoristic kindness to say that the NHS is a ‘victim of its own success’. That’s like saying Piers Morgan is a victim of his own likeability. The bigger any system gets, the more complex its operations, the more removed from individual responsibility becomes every single person in that system. Remove individual responsibility and soon it’s just another trough to shove your snout in. And you can’t blame people for taking advantage, because humans are just another opportunistic species and the snout mentality is never far away.

Corruption doesn’t just have to mean drug companies colluding with the medical profession and skimming off billions. It doesn’t just have to mean management reforms inevitably generating yet more management. It can simply mean taking ‘sick’ days because you can, or going on pointless courses because you can… not caring because you still get paid whether you care or not. This is the British disease, the sick man of Europe resurrected from the shallow grave that Maggie was prevented from digging deep enough.

This is the inevitable conclusion of Statism. It doesn’t matter what works or what doesn’t, it doesn’t matter who dies and who lives, it doesn’t matter who pays for it, or how we pay for it because when we own everything we can control the flow of information too. And we’ve proved it again and again – Hitler, Stalin, Mao; all cut from the same cloth – repeat the lie often enough and people will believe that Big Brother loves them and they will come to love and rely on him. If only we had a state broadcaster in our pocket, too. Oh…

Harsh medicine time for the NHS

So, now we know the NHS is fucked and has been for a long time, how long before realisation dawns that bigger is not necessarily better? Collectivism always erodes individualism, which is fine when everybody is working away in the salt mines, but you can’t have both or rather you can’t have an unlimited amount of both. You might want to consider this when you are deciding what you think about the European Union.