Thursday, November 09, 2006

The Collectivisation Of Healthcare


Protest outside St Peter's A&E

In the wake of that notorious electoral "heat map", NHS Chief Executive David Nicholson has now written to all English MPs warning them of "a wave of closures and fundamental changes to "much loved local services" that may cause strong political emotions in their constituencies".

He's not wrong there. As we all know by now, under the latest government "plans", most local A&E departments are to be axed, and when we next sever a limb we will need to get along to the new super A&Es in either Milton Keynes or Sedgefield. And all around us, as throughout the country, the unconsulted citizenry are up in arms... where they've not been severed, that is.

But amazingly, according to Nicholson, the DoH is not responsible. If MPs want to complain, they need to contact their local health authorities, not the Department.

Eh? Isn't this whole madcap Stalinist collectivisation the DoH's idea? Commissar Nicholson even quotes from Uncle Joe's foreword to the Second Five Year Plan:

"Our aim should not be to preserve the status quo, but to think imaginatively about how we can unlock the resources, both in terms of money and people, to redirect them where most benefit can be achieved for patients ... these are not easy or simple decisions to face up to. If the NHS lacks imagination or courage then it will revert to a series of quick fixes, rather than seizing the opportunities there are to transform the provision of care...

I appreciate that changes to much loved local services often provoke strong emotions and opinions ... I genuinely hope that we can work with you at both a national and local level to develop a mature and open debate."

OK, let's have a mature and open debate, shall we? How about we're fed up with constant revolution top-down one-size-fits-all collectivised healthcare? How about we're fed up with paying £80bn pa for something where we have no say over what's delivered? How about we'd like our money back so we can make our own arrangements privately?

Gawd...look, one more time... the reason the private sector works so much better than the public is that we have customer choice and producer competition. And that process delivers constant improvement, not through a never ending stream of top-down Grand Plans, which may or may not work, but through decentralised trial and error. It's a natural process like evolution, rather than "intelligent design".

And yes, just like evolution, there can be losers. But the winners far outnumber the losers. And IIRC, Stalinism produces one or two losers too.

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