In praise of the NHS

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There’s been a lot to blog about in the last day or so.

And a son in hospital to distract me.

Believe me, I don’t recommend paediatric wards for a good night’s sleep.

But time and again when I witness the willingness of really quite low paid staff to work over, above and beyond the call of duty in the NHS I appreciate three things.

The first is that the neoliberal economist’s view of human nature is profoundly wrong.

Second I realise that the notional ‚Äòownership’ of an activity is largely irrelevant to the effectiveness of its delivery. What is important, first of all, that the service be properly designed to meet a need and second that the people supplying it ensure it meets the need of those using it. Then and only then will it be fit for purpose. If it is fit for purpose the right structure in which the service can be supplied can be determined – but that it in very many cases is an afterthought. Not all, of course, but in many. And if that sounds like a reversal of normal logic - let me assure you it is, and deliberately so.

Third, in this particular case if anyone thought that ‚Äòcompetition’ or ‚Äòmarket forces’ would improve the outcome then they’re, very politely, stark raving bonkers because in this situation one thing matters – which is that my son gets better (as he will – over the next few days; he’s pretty poorly but not in any danger). The only selection criteria in this case was that there was a facility – one facility - but the best one possible - to treat him.

Certainly that facility requires regulation to ensure it is the best available, of course. But two facilities, each inevitably more poorly resourced in a rural area where capacity has to be limited, would be crazy, a waste of resources, expensive and almost certainly sub-optimal – as one would definitely not be the best.

That idea of the duality competition would require would be as crazy as it would be too think that the staff servicing such a facility would be more motivated if they thought that it’s provider was seeking to make profit from those who needed to use its services when very clearly I would much rather not do so if I had a choice – for I have no wish that my son be ill.

And if that suggests that state ownership in this case reconciles two conflicting and entirely contradictory facts – that I want very much that this facility be available and at the same time want to use it as little as possible – then yes that is true and deliberately so.

The ability to hold two and quite contradictory opinions at the same time is an inherent paradox of being human. And it’s quite incomprehensible to the neo-liberal economist.