Category Archives: National Health Service

The NHS teddy-bear

Health service agitprop

No good crisis should go to waste, writes Dalrymple, and

the priests of Britain’s secular religion, its highly centralised National Health Service, have not been sitting on their hands.

There has been so much NHS propaganda during the Chinese flu crisis that one might have believed that the propaganda

was under central direction.

The NHS evangelicals deliberately confound the health service bureaucracy with the devotion and skill of doctors and nurses, but of course

they are not the same thing — very far from it.

Emotional kitsch

Our NHS

Dalrymple points out that the propaganda in favour of Britain’s sovietised health service

has been more or less continuous since its foundation in 1948, though it has become shriller as it departs further from reality. The purpose of propaganda is to forestall any examination of reality in favour of simplistic slogans convenient to power.

There is a striking willingness in many of the people who are the objects of the propaganda

to repeat and believe a slogan without any compulsion to do so, and without the slightest inclination to examine its truth — indeed, without any awareness of the need for such an examination.

There was no oppressive force to deter these people from inquiry,

but they preferred the comfort the slogan offered to the effort and possible discomfort of finding the truth. The idea of the NHS played the role of teddy-bear to a population with many anxieties.

People will have experienced deficiencies in the failing service — long waiting times, offhand or disagreeable interactions with the bureaucracy, etc. But

like Russian peasants who believed that the Czar knew nothing of the oppression which they suffered, and would have put an end to it if he had known, the British continued to believe that the NHS had been born with original virtue and that the defects they experienced were exceptions. Repeated scandals of gross neglect or sub-standard treatment were shrugged off.

Dog in the manger

The British, Dalrymple notes,

were inclined to believe that if the NHS was unpleasant to negotiate, at least (being more or less a monopoly) it was equally unpleasant for everyone. Fairness and justice were equated with equal misery.

He explains that

the uncritical national admiration, approaching worship, of the NHS has required the subliminal acceptance of a certain historiography: before the NHS, nothing; after it, everything. Before 1948, the poor received no treatment but were left to fend for themselves when they were sick, and more or less, to die. After 1948, the ever-solicitous state system looked tenderly after the health of the population from cradle to grave.

The NHS has had no egalitarian outcome, rather the opposite,

yet the belief in its levelling effect persists.

The NHS propaganda

has been so successful that it now accords with the sentiments of the population, a triumph that no communist regime achieved despite Herculean efforts at indoctrination. The triumph has been achieved without compulsion or violence, and ought to be an interesting case for political scientists who study the successful inculcation of political mythology.

The envy of the world

Millions believed this about the NHS, writes Dalrymple. The slogan, he says,

was last wheeled out in any force in 2008 for the 60th anniversary of its founding.

He asks:

Who were the people doing the envying — not just one or two of them, but en masse? It is no doubt true that immigrants from very poor countries were pleased enough to receive care under the NHS, comparing it with what they would have received at home. But is it really much of an achievement for a developed country to have healthcare better than that in Somalia or Bangladesh?

Dalrymple points out that it never occurred to those who repeated the slogan

to look to comparable countries across the Channel or North Sea to see whether those countries had anything to envy. In fact, between 1948 and 1975, even Spain under Franco performed better in the matter of improving the health of the population than did Britain. In most respects Britain limped behind other countries.

The statistics, he notes,

are not favourable to the NHS if one chooses reasonable standards of comparison, namely other European countries. The results are not disastrous, but they are not good. The NHS has failed even in its egalitarian goal: the gap between the health of the richest and poorest in society has only grown under its dispensation.

The mass NHS delusion

No one on the Continent would choose Britain as their country of medical care, rather the reverse

Some people think, or pretend to believe, that if they fall seriously ill in any country other than Britain, they will be treated very badly or simply left to die. It is as if in such benighted lands without the National Health Service, doctors and nurses work with neither skill nor devotion.

But Dalrymple points out that the NHS

is neither necessary nor sufficient for medical and nursing staff to show devotion. The parents of a well-taught schoolchild do not thank the Ministry of Education.

If a German were to say, ‘For God’s sake, get me to the NHS,’ a psychiatrist would be called

Dalrymple says the UK ought to face up to the fact that

being ill and seeking treatment is a more unpleasant experience in Britain than in it is many civilised countries.

The NHS has not served the nation well, if international comparison is the criterion by which it should be judged. For example, says Dalrymple,

  • when the NHS was founded (when British healthcare was among the best rather than the worst in Europe) the population of France had a life expectancy six years lower than that of Britain; it is now two years higher.
  • The health of the population in Spain improved more under Franco than that of the British under the NHS in the same years.

Manifold deficiencies

The comparisons hardly

suggest any particular virtue to the NHS.

Survival from many serious illnesses such as cancer, heart attacks and strokes

is lower in Britain than in most European countries. These statistics are not apparent to patients or their relatives, and in any case the NHS is immune to criticism because its deficiencies are assumed to be departures from its essential goodness or the result of inadequate funding.

Innumerable scandals

No number of scandals,

such as that of Mid-Staffs in which hundreds of patients were neglected to a degree that often defied belief, all in plain sight of a large bureaucracy supposedly devoted to ensuring the quality of patient care, can dent faith in the NHS. Staff committed, and management connived at, acts of cruelty that would have made Mrs Gamp blush. Mr Cameron’s government, anxious not to seem an enemy of the NHS, which would have been politically damaging, swept the scandal under the carpet.

Dalrymple suspects that

the sheer unpleasantness of the NHS is reassuring to the British population. It evokes the Dunkirk spirit: we are all stranded on the beach of illness together. And if we cannot all live in luxury, we can at least all die in squalor. Justice is served.

The NHS egalitarian? Far from it

The justification for Britain’s nationalisation of healthcare was egalitarianism. Yet the National Health Service, writes Dalrymple,

has failed even in the matter of equality. The difference between the health of the richest and poorest sections of the population has increased rather than decreased under the NHS.

The gap between the life expectancy of unskilled workers and that of the upper echelons, which had been stable for decades before the foundation of the NHS,

began to widen afterwards, and is now far wider than it ever was. If systems are to be judged by their effects, the NHS has failed in its initial goal.

It is a matter of common experience, Dalrymple notes,

that members of the middle classes are far better able to derive benefits from the system than the lower classes. Members of the middle classes complain where the lower orders swear, and bureaucrats are aware that articulacy is a more dangerous enemy than assaults on staff can ever be.

Doctors just following orders

Superior orders

Befehl ist Befehl

Dalrymple points out that under Britain’s National Health Service, doctors

are becoming ever less members of a liberal profession and ever more executors of orders from on high.

They have

little leeway to consider whether these orders are good or bad in the individual case before them.

He notes that this is a problem in all systems in which a third party pays for patients’ treatment,

but it is acute in a highly centralised and dirigiste system such as the NHS, in which uniformity is the goal, even if it be uniformity of error.

Increasingly,

it creates an atmosphere of technical, managerial and ethical conformity.

Britain’s NHS: rhetoric and mythos

The UK’s state health service is, to put it most kindly, mediocre by comparison with that of other countries at a similar level of economic development. Yet the British prime minister has described it as the nation’s ‘greatest national asset’. Dalrymple notes that, in reinforcing NHS mythology, Boris Johnson appears to be

politically shrewd. One casts no doubt on the perfection of the Koran in Mecca.

The riddle, says Dalrymple, is why Britishers hold a service which has failed them in such affection. The question ought to be of interest to political scientists, but the answer is unlikely to please

those who believe in rationality,

for the affection

represents the triumph of rhetoric over reality.

There is an implied historiography in which

the pre-NHS era is akin to jahiliyyah, the time of ignorance before the advent of Mohammed.

The myth that there was no healthcare for most of the population before the NHS

has for decades been continuously and successfully insinuated into the minds of the population. It has been Britain’s pale imitation of totalitarian propaganda.

When retired doctors such as Dalrymple were asked to return to work,

it was to help the NHS. This was like asking a soldier to lay down his life for the sake of the Ministry of Defence.

It says something about the credulity of British people, he observes,

that the response to slogans like ‘protect the NHS’ was dull compliance rather than outraged demands as to why it was not protecting us.

👏🏻Clap for the NHS👏🏻 is to gestures what Jeff Koons is to art

Every Thursday at 8pm, Britishers are required to come to their windows and hail 🙏🏻the NHS bureaucracy🙏🏻. Applause must be long, loud, and accompanied, Dalrymple notes,

with ululations.

He dislikes such actions,

which seem to me empty and shallow. They are supposed to be gestures of gratitude and encouragement, but all that I have seen suggests that doctors and nurses are more irritated than pleased by them. Often they have to work in poor conditions, with essential equipment lacking despite the vast expenditure on the health service.

He points out that thus to genuflect is cheap.

It costs nothing, financially or in any other way.

The Danube of Thought: cheer him to the rafters

There is also

something unpleasant about it. When lots of people make a gesture collectively, there is often the implication that if you refrain from making it—and even worse if you actively refuse to make it—you are in some sense an enemy, in this case, of the people. Whatever your inner conviction, it is safest to join in. By doing so you avoid drawing attention to yourself and you are assumed to think and feel like everyone else, which is always safest.

It reminds Dalrymple, in its tendency to get longer and louder and almost more hysterical,

of the applause after a speech by Nicolae Ceaușescu or any other communist despot, in which everyone in the audience had to show himself to be as enthusiastic as the most enthusiastic applauder, and to continue applauding as long as someone else was applauding, for to be the first to stop might be taken as a sign of disloyalty and dissent from the official line.

His objection is also æsthetic:

I find it to be emotionally kitsch.

The sort of ‘art’ excreted by Jeff Koons: Play-Doh (five versions, 1994-2014)

Getting to see a GP is a labour of Hercules

Securing a five-minute slot with a family doctor in Britain’s Soviet-style health system is extremely difficult. It is necessary, Dalrymple explains, for the patient

to lie or exaggerate. He must become expert at doing so.

If you are lucky enough to be granted an appointment, for three weeks’ time,

it is awarded as if it were a minor decoration — an OBE, say, for exceptional persistence. You have joined the privileged few. You should be proud and grateful.

NHS superstition

The British people are deeply attached to an institution that fails them

The delusion is as follows, Dalrymple writes.

Before the establishment of the National Health Service in 1948, there was little healthcare to speak of for the poor in England. After its establishment, healthcare was universal, of high quality and free at the point of use. This led to an egalitarian paradise where healthcare is concerned, preferable to anything else on the face of the earth. The NHS was and remains the envy of the world.

He points out that

a large proportion of the British population has been persuaded of the truth of this myth, by assiduous and insidious propaganda, such that the NHS is a sacred cow which no politician dare slaughter. The myth is believed as an orthodox Moslem believes in the sacred nature of the Koran.

Dalrymple explains that the NHS is

neither as catastrophically bad as is sometimes alleged, nor as miraculously good as its religionists claim. It is mediocre at best and an unworthy object of the uncritical praise bestowed upon it by its worshippers, that is to say the majority of the British population. A brief survey of reality demonstrates that a myth has been swallowed whole.

It is

far from the miracle-working organisation that the population supposes it to be, a supposition that paralyses all thought. On the 70th anniversary of the establishment of the NHS, there was an orgy of self-congratulation about it (the fatuous opening tableau of the London Olympics in 2012 celebrated the NHS).

The religious veneration in which it is held

is an extraordinary political phenomenon, a superstition that would be worthy of a chapter in an updated version of Charles Mackay’s book of 1841, Memoirs of Extraordinary Popular Delusions and the Madness of Crowds. The disjunction between myth and reality should be of interest to political scientists and philosophers.

Having reached the age at which he is likely to need healthcare, Dalrymple knows that the NHS

will treat me as a pauper: I must accept what I am given and receive it uncomplainingly with a sense of gratitude for the charity disbursed to me, irrespective of its quality. That freeborn Englishmen have so willingly acceded to their pauperisation in the name of equality and security (what they receive may not be the best, but they can at least be assured that they will receive something), and in the process suppressed their critical faculties, is a fascinating, if minor, episode in human political evolution.

The NHS must cease to be our state religion

Holy cow! Common sense about Britain’s health service

Among the myths about the UK’s National Health Service, Dalrymple notes,

is that, before it started, there was no decent healthcare to speak of. This is false. The health of the population improved at the same rate before the NHS as after it. Horror stories could be told about healthcare before the NHS, of course, but they are not lacking afterwards either.

There is no more reason to worship the NHS, he writes, than to worship

the Inland Revenue or the Department of Fisheries and Agriculture. It is not the product of some Immaculate Conception. It is not heresy to doubt its perfection. It has its advantages and its disadvantages, and at the moment its disadvantages are becoming more obvious.

The slogan ‘Save our NHS’ is therefore completely wrong.

It asks the wrong question, and if you ask the wrong ­question you will get the wrong answer. You might as well say ‘Save our old ­typewriters’. It is not a question of saving anything — it is a question of improving our healthcare, preferably so that it is not always struggling at the bottom of the European league, as it has been now for several decades.

It is time we stopped treating the NHS as a golden calf

Dalrymple points out that

no system is perfect and people ­grumble everywhere. But the NHS makes paupers of us all, in that we must accept what we are given. Often what we are given is good, but often it is not. We need to look honestly at all other healthcare systems. The Singaporean one combines high quality with low cost while still serving all of the population, and the Germans ­combine statutory health insurance with private funding. We shall have to stop pretending that we can run a service that is both ­universal — covering ­everything medical that can ­possibly be done — and is also free at the point of use. If we insist on such a system, the only thing that will be universal will be our continued second-rateness.

The first absolutely necessary step, Dalrymple says,

is to stop worshipping the NHS as if it were a god. If we do not stop thinking of it as the envy of the world, we shall never be able to change it for something better, because no government will dare even to try.