Hi Keith,
Based on my experience living in England for several years in the 1970's quite close to the belly of that beast (in Cambridge) what you are saying seems consistent with what I saw... But as a consequence, I think it rather awkward for you to attempt to generalize from the clearly somewhat skewed experience in the UK with bureaucratic management/social democracy to other jurisdictions or toward universal conclusions. Also, certainly there is on the part of Canadians a degree of envy at the US financial success and a degree of animosity at the overweening attitudes of the US and its indifference to the impact of its often short-sighted and imperious behaviour on its Northern neighbour. But our Canadian traditions of the use of the State for supporting and promoting the public good are one's of which we have been very proud, and in the case of health care we use as a major source of differentiating ourselves from the US. MG -----Original Message----- From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]]On Behalf Of Keith Hudson Sent: January 25, 2002 8:03 AM To: Michael Gurstein Cc: [EMAIL PROTECTED] Subject: Class-ridden society (was RE: The Health Care Workplace in Crisis) Hi Mike, At 07:35 24/01/02 -0500, you wrote: >It sounds to me Keith, that these problems in the UK Health Sector have much >less to do with any structures of management whether State supported or not, >but rather that somehow this sector has managed to maintain rather >traditional British systems (to use the Sociological terms) of status based >privilege. These were rife throughout British society when I last lived >there in the 1970's and which (to her credit) Dame Margaret managed to sweep >away from many parts of British society. > >When I last had any direct observation, all of that was very specific to >Merrie Olde and was based on historical factors which completely by-passed >most of the rest of the World. Yes, England is still a class-ridden society. Please excuse the following disquisition (albeit as brief as I can make it) -- my apologies if I'm trying to teach my sociological grandmother to suck eggs. The NHS as from 1947 was really a continuation of the sort of highly centralised civil service control that started at around 1870/90 when there was a new "species" of thousands of middle-class scions of those nouveau-riche industrialists and merchants who came into existence during the earlier part of the century. The brightest of these trooped into Oxford and Cambridge U's, joined the pre-existing aristocracy and turned their backs on the lowly origins of their family wealth. The importance of this wave of talented and sizeable group can hardly be overestimated. Historians are only just realising the full impact of this new class (mainly in the arts, politics and the professions). There was already a highly demarcated, but effete, landed aristocracy and this new group simply implanted themselves into this -- with the existing deferentialist society staying in place all around them. Thus in their own new meritocratic ways, the new Oxbridge class continued to extract advantage from the country at large -- this time by manipulation rather than the exercise of brute power. So this is really the tradition of the civil service in this country -- aided and abetted by the fact that England was sufficiently small (geographically) for the new sort of power to be exercised directly from the clublands of London and able to drain away the powers of the industrial cities of the north.* And the civil service has had considerable power ever since, able to influence governments of whatever persuasion, able to consolidate itself at every turn, whatever new policies were brought in. Also, two World Wars greatly helped. It's only been in the two or three decades that the power of the civil service has begun to wane because the very brightest of the Oxbridge brigade were no longer automatically entering the civil service, the arts or the professions but also going into the new sorts of multinationals taking over from traditional manufacturing. (*The local authorities of which, incidentally, made the greatest strides in health improvement, long before a powerful civil service came on the scene.) So you have nothing like this in Canada. The "similarities" (shortages of doctors, nurses and other health professionals) thus appear to be coincidental -- as you suggest below: (MG) >The problems with the Canadian Health Care System are certainly not that--we >don't have much centralized management; no NHS for example, rather, I think >the problems lie deeper in the general malaise of the Canadian >economy/dollar which has fallen dramatically against the US$ over the last >ten years or so, while so many of our health inputs are either priced in US$ >(technology) or have to compete for resources (people) with >folks/institutions waving US$ salaries. I don't know enough about Canada to comment on this, save to say that from over the water we generally confuse Canadians with Americans (I certainly do) and find it surprising that there are animosities between you. Keith Hudson __________________________________________________________ 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] _________________________________________________
