--- Begin Forwarded Message ---
Date: Fri, 30 May 2003 05:53:41 EDT
From: [log in to unmask]
Subject: Re: Blair says whole of NHS should be
opened up to competition
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Dear Alex
I don't usually respond to these general
emails. But I do have to take issue with the
idea of a 'caring culture' in the NHS. Walk in
to any A&E department and see how caring it is.
Spent 10 hours being ignored by staff. There
are real problems with the NHS system - which I
happen to think this government does not really
understand - but I have come to the view that
"private bad/public NHS good" is not
sustainable.
Hips, knees and eyes are examples of
procedures where the private/NHS provision
distinction is full of holes. As an anecdote,
I know of a surgeon that scedules 5 cataracts
per list in his NHS session and 12 per list in
the private session. To me that is an example
of how incentives can be used to improve
productivity, rather than an argument for
abolishing the private sector.
The main area where the NHS fails patients is
in diagostics. A patient can spend 2 years in
an outpatient system being passed from
consultant to junior to pathologist to
radiologist, with no momentum. In the private
sector all those tests would be organised in
one week, with a speedy diagnosis, avoiding
real distress to the patient and cost to the
system.
I could go on. - For example, my father was in
hospital for 2 weeks for 2 simple diagnostic
procedures that could have been done in half a
day. No real hurry to discharge, even though
he was desperate to get out. The point is that
this is based on experience, and the pressure
to change the NHS is supported by the contrast
that patients and doctors see between the
treatment here and abroad. We have a creaking
system and the 1948 structure (which is
effectively intact) is based on low
expectations. 'Caring culture' is like a red
rag to a bull when you've been on the receiving
end.
Tessa Crilly
On Fri, 30 May 2003 16:37:03 +0100 Theodore
MacDonald <[log in to unmask]>
wrote:
Dear Alex:
It is to your correspondent Tessa that I wish
ti direct this reply and it is only my
IT-ineptitude that makes it difficult to get
onto her e-mail. However, now that I think of
it, it might as well hit the "general list".
I have often heard Tessa's argument from people
swho, like her, have had personally distressing
experiences with the NHS which disappeared when
they went private.
However, I think such people might find it
valuable to stand back a bit and consider the
matter in the broadest context. Private, even
as things stand now, is often terrifyingly
worse because of lack of staff in some
private clinics. But let's leave that aside.
The real issue is political rationality. At the
fiscal level, there is no point in a group
running medical care privately UNLESS they can
make a porofit. Private business does not run
on charitable or broader philosophical lines.
It fails if it doesn't generate In theory,
publicly owned and administered enterprises (in
health or education or many other
enterprises)can use what would have been
profit" to increase the social impact of its
activities. Its criteria for "success" would
only be what proportio of the citizenry it can
reach and how effectively. From the beginning
the foundations of the NHS had to be
compromised by the fact that it was organized
within the broader concept of capitalism rather
than socialis. The great "saints" of our NHS,
politicians like Nye Bevan, thinkers like
Emanuel Shinwell, even Beveridge and Titmuss
himself, could not follow through on an
irrefutable socialist logic because that was
not the realpolitik.
We CAN make the NHS do what it was intended to
do, but to do so involved a rather
comprehensive change in the prevailing
mind-set. Much more than the details of
healthcare are involved. There has to be a
sustained shift away from individualist
thinking toward community thinking. This will
not be easy. Almost all of the nicely packaged
pat formulae have so far let us down and many
people find themselves eschewing "poltics" and
routine political processes because they can't
stomach cant and propaganda. But I see many
positive signs. Among these are a growing
realisation that environmental issues are
fundamental to long-term civilisation. The
standard "politicos" and the media like to
assurew us that such concerns are "unrealistic"
Increasingly we are realising that they are the
only realistic concerns. The people who DON'T
want us to start thinking that way are making
lots of money and power out of the status quo.
The gap between the "haves" and the "have-nots"
is increasing, not shrinking. We can only
reject these uncomfortable facts by saying:
"Forget about the 30% living on less than $1.90
(US) daily". I can't believe that Tessa and
thousands of others who have coped with their
own health problems and suffered for it, want
to think like that.
We all need, in our own little ways and through
organizations, do every thing we can to promote
what is logical and just world-wide. In doing
so, more localized problems like healthcare in
the UK, be improved. To try to go the other way
will only bring short-term relief to some and
will inevitably fall pray to that need for
the private alternative to generate a profit
for their stock-holders. The party won't last
long.
In closing, may I thank Tessa for articukating
her despair so articulately.
Theo MacDonald
On Sun, 1 Jun 2003 09:29:08 EDT
[log in to unmask] wrote:
I'm in a tabloid hell. "Neurotic woman
requires dose of intellectual rigour for rapid
enlightenment". Really? The mantle of
personal despair, as Theo puts it, is worn
lightly by me since I have been describing
typical experiences. The A&E debacle is not a
media construct; it is real and affects the
powerless most of all - people who sit and
hope rather than make themselves awkward.
Criticism of the current system has nothing to
do with favouring haves over have-nots.
People travel. They go to France, come back
after their heart attack with a CD of digital
radiological images that they can drop in the
UK consultant's lap. (Delivered with some
satisfaction by the French cardiologist). GPs
go to Canada and realise that their colleagues
can arrange diagnostic tests immediately by
phone rather than sending the patient through
tedious outpatient assessment clinics. The
creaking health system I referred to is a
function of resource allocation,
hyper-complexity and an organisational
stuckness. I'm not advocating any specific
solution, but pleading that we should not get
boxed into a rigid approach that relies on how
we think a system should work, even if in
practice it doesn't happen quite like that
(back to the Caring Culture mantra).
Experience is data and theory has to bend to
reflect events, or we're forever
flat-earthing, while everyone else zips out of
sight over the horizon.
Tessa Crilly
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