Dalrymple lists the failings of the Mid-Staffordshire NHS Trust:
- the ravening ambition of bureaucratic mediocrities
- institutionally perverted incentives that reward those who do worst
- the creation of a nomenklatura…at the head of an apparat staffed by bullied, intimidated, fearful but…unscrupulous apparatchiks
- an inability or unwillingness to speak or write in plain English
- intellectual dishonesty with compulsory lying on a vast scale
- the proliferation of procedural objectives and bureaucratic tasks…unrelated…to reality or to the welfare of patients
- a revolting tendency to Pecksniffian self-congratulation and righteousness
He calls the NHS
that vast charitable organisation for the outdoor relief of second-rate bureaucrats.
He points to the slick insidiousness of Tony Blair, who made Labour, once the party of the working class, the party of the nomenklatura. But Dalrymple’s greatest scorn is reserved for arguably the most overrated post-war British prime minister, Margaret Thatcher,
with her crude sub-Marxist view of the professions as…exploitative monopolists….She thought the methods and disciplines of the marketplace, imposed by ‘scientific’ management but in the absence of anything resembling a…market, would eliminate chronic inefficiency….This was…stupid…it called into being a managerial class, cunning and unscrupulous.