Sunday, 30 March 2008

The BBC and fundamentalist NHS reform

This BBC piece of 'journalism' starts off with a glaring error and then proceeds to serve as an advertisement for the government's deeply flawed ideological reform of health care (note original has since been amended).

"Patients with acute conditions like multiple sclerosis and diabetes could get control of their own NHS budgets to buy treatment, the government has said."

Firstly diabetes and MS are chronic conditions which may present acutely, so the BBC has got this completely wrong in the first paragraph. The pursuit of choice in the health care system is beginning to appear rather religious in its nature:

"Choice is a means to an end, the end being better quality and more personalisation of healthcare. Choice, combined with payment by results, is an important driver of quality."

The government took us to war in Iraq because of a flawed belief that violent regime change would be the means to an end, the end being the Utopian style of government that is western democratic capitalism. Their naive ideological pursuit is failing dismally there.

There are parallels between Iraq and the NHS. In both situations the government is trying to apply a one size fits all ideology to a situation that is eminently more complicated and intricate than they realise. In both cases they have a misguided and almost 'religious' belief in an ideology that is a means to an end, the end in both cases is seen by them as an achievable utopia. They are stupid and deeply misguided.

As is excellently point out here, anyone who sees that there is an end point in the provision of the perfect health care system is most likely an imbecile, a politician or both. All systems have their flaws and there unfortunately is no utopia. The government's ideological pursuit of a market in health care, when finite resources are available to manage an exponential demand, is deeply flawed. This reform is leading to more and more money being wasted on creating the market, managing the market, rigging the market and fiddling with the market.

The end result is an NHS in which more and more money is diverted away from patient care and towards a burgeoning bureaucracy. Just like Marxism, fundimentalist free market capitalism exhibits all the hallmarks of deluded religious thinking; their ideology is a means to a perfect end, the end justifies any means and they cannot be wrong. To hell with reason.


Fx said...

A couple of points, Garth

The first is that I was particularly struck - no doubt you were too - by the BBC's "those who need (sic) elective surgery" were to have control of their own funding. Lol! Might not be there now - read it earlier.

The second is that a Marxist analysis of what you doctors are going through now is that it is *capitalism* that goes in for this deskilling process - the theory of the organic composition of capital. This is a right wing government, not a left wing one. Admittedly, it's hard to tell the difference when it's so extreme. We're not used to extreme politicians being in government in this country.

They might call themselves Labour, but they don't represent the workers any more.


Fx said...

Oops! Read that end bit again and ... you said that. Duh!


Garth Marenghi said...

I was just making the point that marxism and free market capitalism are modern day religions of sorts.

By this I mean that they value belief in their ideology over reason.

Fx said...

I think its a bit more complex than that, Garth. Standardization in the modern world wins over altruism ... and I'm guessing that most doctors go into the profession for motives of altruism. Most managers, on the other hand, go into any area - not just health - for reasons of efficiency and finance.

Two completely unrelated approaches at complete odds with each other. I don't envy you.


Garth Marenghi said...

the point I'm trying to make is that a lot of the people pushing through policy do thinks as simply as that, that's the problem,

top down intervention is hard enough, but using a naive one size fits all strategy makes it completely impossible,

health care systems are incredibly different around the world and even if one country's system was shown to be better than anothers (very hypothetical as this has not happened) then it couldn't just be copied and expected to do as well elsewhere

Fx said...

I know that's your point, Garth. I've said before that the profession is going through a process of deskilling - only took 100 years from manufacturing through to the professions - yours isn't the only one.

One of the many problems is that from your point of view, government is irrational - I mean, who in their right mind would take a perfectly good trained professional, look at what s/he does, break it all down into individual tasks and train up individual workers to do those individual tasks without any context?

From a government/management point of view it makes perfect sense and you doctors are the ones who are irrationally holding on to boring repetitive tasks better suited to those further down the line.

Both these views are held with the underlying reasoning being the same: training doctors takes time and money.

I am not arguing for it or against it. Simply pointing it out.

How can you put a stop to the process? I think reorganising the BMA more along the lines of a Trades Union than a professional body might help - Trades Unions [back when they weren't service providers to commerce] insisted not just on pay and conditions negotiations, but started sending representitives to parliament in order to change the system.

Of course, being a middle class professional, you are probably appalled by that thought ... ;)


Garth Marenghi said...

I know that's what your pointing out, I am always keen to explain why this results in a crap health care service.

I agree, the BMA need to change the way they pressure the government, they are far too limp and spend too much time waffling on about boxing an alcohol rather than representing doctors.