Nearly there now
As the Doc has described many times, Labour's NHS is a huge Stalinist meat processing factory through which patients are transported on a series of conveyor belts.
The belts are picturesquely known as Patient Pathways, and alongside five year plans, mandatory organisational protocols, and do-or-die output quotas, they are central to the way the Bureau of State Health Production directs its massive industrial empire. That, and summary execution for managers who fail to deliver their published quotas.
And just so you know, here's what an NHS pathway looks like (click on image to enlarge):
Well, it now turns out that the entire empire has been on a pathway of its own. According to State Health Commissar my Lord Darzi:
“The NHS is continuing a journey of improvements, moving from a service that has rightly focused on increasing the quantity of care to one that focuses on improving the quality of care."A journey of improvements - aka Marxist-Leninism. The Dictatorship of the Proletariat is a necessary but temporary stage on our journey to a workers' paradise of plenty and fairness for all.
What my Lord was trying to explain away was the latest evidence that organising healthcare as a Stalinist meat packing factory is a shocking idea. Patients get treated as lumps of condemned offal, staff get deskilled and demotivated, managers... but look, don't listen to me, listen to the government's own assessment report - a report they tried to suppress:
“The patient doesn’t seem to be in the picture... We were struck by the virtual absence of mention of patients and families ... whether we were discussing aims and ambition for improvement, measurement of progress or any other topic relevant to quality... Most targets and standards appear to be defined in professional, organisational and political terms, not in terms of patients’ experience of care...And that's the entire problem with Big Government - the needs and preferences of individuals no longer count, and our public services end up serving a bunch of arrogant ill-informed commissars closeted miles away from the action, who in many cases don't even use the services they are inflicting on everyone else.
The GP and consultant contracts are de-professionalising, and have had the peculiar effect of simultaneously demoralising and enriching doctors. We’ve lost the volitional work of the doctors and far too many of us are now just working to rule...
The risk of consequences to managers is much greater for not meeting expectations from above than for not meeting expectations of patients and families.”
Yet despite manifest failure right across our public services, the so-called Progressive Consensus still seems to think that Big Government is the best way forward. Just like Stalin, they are prepared to accept as statistics the deaths and broken lives that result from Big Government failure. They are prepared to accept the costs and inefficiency that Big Government always entails.
Well, because they believe they're on the side of the angels.
Take Michael Foot. Obviously he was a deeply flawed individual, who held fellow travelling views repugnant to most of the British population, and who would certainly have bankrupted us had he ever become PM. But both he and his Prog Con supporters honestly believed he was A Good Man who intended only to do good for the proletariat. And those good intentions somehow absolved him from responsibility for his dangerous and deluded ideas on how to realise them.
And that's the thing about good intentions. They've paved no end of hellish pathways. From the Mid-Staffs NHS Trust all the way to the Gulag Archipelago.
There is only one path to better public services. Which is to break up our top down commissariats, to have providers compete for customers, and to put the spending power into the hands of the individual customers themselves. And as we face a decade of spending cuts and low growth, it is more important than ever for us to get onto that path.