Ray Harrel asks me what are the reasons for the continuing collapse of the National Health Service in England (and the Education system as well for that matter)?
This, briefly, is my answer: 1. The health services, which previously covered 100% of the population, and paid for by 95%, should never have been nationalised in 1947; 2. The NHS should never have been a multi-layered pyramidal-shaped organisation of the sort much favoured by the civil service (for the obvious reasons of giving many career opportunities). This means that its channels of communication become increasingly choked at higher levels because they cannot cope with feedback information flowing from the customer. It should have been lateralised a long time ago -- like all large industries. 3. England has the wrong population size. The NHS (even as a nationalised industry) would have been much more efficient in either a larger semi-decentralised federalised state (such as America) or a smaller centralised state (such as Sweden). 4. The Royal Colleges (of Physicians, etc, etc,) are protective practices and still exercise control over entry -- social affability, family and contacts being more important than brains. (Anecdote: my ex-brother-in-law, a PhD in particle physics from Oxford, once told me that the medical faculty was the least intelligent of any at Oxford. That was 40 years ago but I doubt it's changed.) (Another anecdote -- this time a present-day one. The doctor who blew the whistle over the death-rate of children at a Bristol hospital three years ago (three times higher than any other hospital because of two incompetent surgeons) lost his job was effectively drummed out of the country by one of the Royal Colleges. He is now a Professor in Australia.) 5. Ordinary Doctors and Nurses (as opposed to Consultants) are treated with something close to contempt by (a) the senior managements of the health service, (b) the Department of Health, (c) the Royal Colleges. This is why a quarter of doctors and nurses don't complete their courses and why a further quarter leave within two years of qualifying. Alan Milburn, the Health Minister has now got to move very fast now in order to prevent the complete collapse of morale in, and operations of, the NHS in the coming years. He is obviously doing so with respect to sending patients to other countries for necessary operations.* Whether he can decentralise the NHS sufficiently quickly and genuinely motivate doctors and nurses is entirely another matter. *This also contains the seeds for further explosions of public opinion in England. For the first time, we are seeing on our TV screens the superlative standards of the typical wards and operating theatres in France, Germany and Spain, besides which our own hospitals seem like rabbit warrens, and dingy, dirty ones at that -- with antibiotic-resistant bugs resident in every single hospital in the country. ---- In short Ray, the problems of the NHS have been growing apace for 20/30 years and it's only been ideological pig-headedness which has resisted any substantive reform. Keith __________________________________________________________ �Writers used to write because they had something to say; now they write in order to discover if they have something to say.� John D. Barrow _________________________________________________ Keith Hudson, Bath, England; e-mail: [EMAIL PROTECTED] _________________________________________________
