Yesterday’s report from the NHS Ombudsman, which found that hospitals were failing to meet even basic standards of care for the over-65s, made for grim reading. Without getting into the gruesome details of individual cases (see here for more), the Ombudsman’s comments more or less sum it up:
The findings of my investigations reveal an attitude – both personal and institutional – which fails to recognise the humanity and individuality of the people concerned and to respond to them with sensitivity, compassion and professionalism.
The reasonable expectation that an older person or their family may have of dignified, pain-free end of life care in clean surroundings in hospital is not being fulfilled. Instead, these accounts present a picture of NHS provision that is failing to meet even the most basic standards of care.
Crucially, the Ombudsman, Ann Abraham, said that this was not a question of resources, but rather a problem with the “culture” of the National Health Service. But where does this culture, which fails to treat patients as individuals, come from? Could it stem from the fact that the health service is, essentially, a socialist institution?
Just look at the way the NHS works. The government collects money in taxes and decides how much it can devote to healthcare, and then the Department of Health distributes money around the country and sets the rules on how it can be used. Under the supervision of Strategic Health Authorities, Primary Care Trusts decide how to spend that money in accordance with the government’s wishes, and healthcare providers are commissioned to provide services in accordance with its rules. This is the very epitome of a top-down system, and the very antithesis of a personalized service.
Ultimately, when healthcare is rationed by the state, and all meaningful decisions about its allocation are made by bureaucrats, it is inevitable that patients will be treated as a burden, as a cost, and not – as they should be – as customers who have purchased a service with their taxes. That’s the root of this “culture” of neglect in the NHS, which says, “Shut up, and be grateful for what you’re given”.
And unless you have enough money to go private, there’s nothing you can do about it. There’s no exit option, no choice, as exists in any real market. Your only input comes once every four or five years, when you vote in a general election. But even then, you are voting on competing bundles of policies, covering a wide range of issues. It’s a pretty meaningless exercise.
Frankly, I’ve never understood the affection that so many Britons have for the NHS. To me, it is a disgrace that in an affluent, advanced society, so few people will ever receive the kind of healthcare that they would freely choose for themselves, if only they were given the opportunity. And as long as we persist with a top-down, single-payer, command-and-control system, that isn’t going to change.