Thursday, 14 June 2007

Thick as two short planks

I have been inspired by Patrica Hewitt's latest ramblings to point out some rather glaring errors in her infantile argument:

"The NHS is four times the size of the Cuban economy and more centralised."

She is correct in saying that the NHS is far too centralised, it is also managed in a far too over controlling and top down manner. Unfortunately for Patricia and her moronic cronies this top down centralised structure has been their trademark, they are the main reason for this increasing centralisation.

She also added that services needed to be more 'patient led', a meaningless statement if there ever was one. Under New Labour and Hewitt services have been less and less related to what patients want; they have ignored the wishes of patients time and time again in pushing through their useless ideological reform. They have left us within an inefficient expensive dumbed down internal market where many patients simply have no choice but to suffer inadequate care from non medically qualified staff. She then added that
that competitive pressure could create "startling results for patients", she is right if 'startling' is translated to mean rubbish, dumbed down and shoddy.

There was however a more fundamental flaw running through her illogical purulent splurge, this was her undying belief in the internal market and all types of 'competition'. If analysed in more detail she seems to equate anything 'nationalised' to being antiquated and useless and anything with any kind of market as dynamic and brilliant, this logic belongs at below primary school level. The kind of top down centralised stage managed internal market present in the NHS today can only be bad for the service provided, it simply doesn't matter whether this is done publicly or privately; any system that is so badly managed in a top down fashion will be doomed to failure. Likewise simply because something is state owned does not mean that this thing has to be centralised and top down in nature, there are many examples of great nationalised schemes that have been very bottom up in their approach and they have consequently been extremely successful. It is important that people are genuinely listened to and that services are allowed to spontaneously evolve to adapt to the changing demands of the nation, this can only happen if there is the correct balance between a 'catalytic' style of central management and locally responsive services.

Fundamentally the issue is not whether a service is public or private, the important thing must be whether the service is responsive to the needs of individuals. New Labour have plumbed new depths as far as forcing through policies that are antidemocratic and against the majority's wishes, hence their policies have failed on the whole as they do not have any way of adapting and reacting to the demand of individuals. It is incredibly rich and naive of Hewitt to simplify and dumb down the argument to a childlike level of internal market versus nationalised industry; after all it is ironic that New Labour's 'competitive' internal market has come to represent the most Stalinist failure of them all.


The Spaniard said...

Speaking of Cuba:

I did my elective project at a primary care centre in Havana -

Despite having just $236 per capita (per annum) to spend on health care, the Cubans have basically the same health outcomes as the UK - and better infant mortality than the USA!

Centralised systems can work.

I think the most revealing thing was that the Cuban doctors were shocked to hear that hospital managers in the UK are not clinicians....

'How is that possible?!' they said...

Exactly, I said.

Garth Marenghi said...

good point. Generalisations can only go so far, the bad management of the NHS is irrespective of whether the system is centralised or not, it would still be true that the managers are not knowledgeable in the correct areas.

Interestingly I don't think 'centralisation' has to neccessarily apply to nationalised services, as if they are managed well then they are far from centralised in their structure. There are many over centralised private schemes too, demonstrating the public and private systems cannot be generalised as some like to.