Nurses for Reform Blog

Yesterday I had an article published in the Daily Telegraph, discussing the future of the NHS and how NFR believes the process towards achieving better healthcare for the UK population should be started.

To read to complete article click here.

I also urge you to take time to read the comments.  It is amazing not only how people interpret what I have said differently but also how people have completely different expectations of what the NHS should be and do.

In line with public choice theory economics, I have long believed that health systems driven by greedy vote motivated politicians will have the opposite effect of their professed consequences. It is in this context that one expects to read articles like this. Billions spent and nothing to show for it.

A million miles away from the rhetoric of equality and all that top down pontificating beloved by our political class, the NHS and our wider welfare system is continually exposed for being a deeply dystopian and elitist operation. Its masters pretend otherwise. But, as Stephen Pollard and Andrew (now Lord) Adonis argued in their excellent book, A Class Act, Myth of Britain’s Classless Society,  the NHS is the microcosom of a class based system. That is what it is.

It has essentially white male doctors and administrators at the top and a raft of poorly paid ethnic minorities doing the auxiliary services at the bottom. As a system overseen by the ‘Royal’ Colleges, built on legislative favour, and which taxes ordinary people to the tune of more than £100 billion a year, is it any wonder that the poor are kept poor – and made ill earlier?

Forget social justice and equality. The key to making poor people healthier is to enable them to get rich. That is why government should get out of the way.  Indeed, it should allow welfare to flourish without the state. Forget politics and coercion. What we want is much more open, diverse and dynamic forms of health and welfare organised bottom up.

Following this post the Daily Mirror published this rather good article:  Apart from making the mistake that NFR is in anyway allied to the Tories (that is offensive!), it helps to get some important history out in the public domain. Intellectually, the NHS and the welfare-warfare state does have some unsavory roots that no one should deny.

Indeed, there have been two recent comments posted on this blog that are so good I have decided to reproduce them here. Here is number one;

“The history behind the NHS and the eugenics movement does have common elements, to pretend otherwise is to live in a fantasy world.

Specifically, it was the beginning of national health statistics in the late 19th century that led to the moral panic of “degeneracy”,which came from the combination of Darwinian ideas applied to social sciences, and the emergence of medical data about the health of working class people.

One part of this panic was to promote the idea of deliberately removing “undesirables”, a process begun in the USA in the early part of the 20th century, but applied most horrifically in Nazi occupied countries from 1933 onwards.

But the other, whilst less violent, had the same objective: the national improvement of collective healthcare. The Fabians originally believed that the “feeble minded” should be institutionalized (given electro-shock therapy), homosexuality was considered “a mental illness” and state control of hospitals became an ideological programme.

This is why Nazi Germany was the first European country to adopt major campaigns against smoking, and why the various prohibitionist movements were strong in late 19th-early 20th century USA and UK.

What part of the NHS’ rationing of healthcare to deny treatment for old people, or smokers, or the obese, do the commentators above think Hitler would object to? I can think of none. As for the smoking ban in pubs: no fascist dictator would have dared introduced such a thing, but Hitler, would certainly approve.

As for A Davidson, I would merely point out, that it seems wise to ask if the reasons for Hitler’s support for socialized healthcare (which you admit) are bad, shouldn’t we consider them? If Hitler was right to think that socilized medicine would advance racialist policies, are we wrong to make sure this does not happen?

One last thought. Harold Shipman. Clearly, this was an extreme individual, but his attitude towards patients was entirely logical, once one accepted the notion that it is not the patient to control healthcare provision or objectives.”

Now, for those of you interested in the burgeoning literature and research into this history – much of it written by socialist writers – see comment number two:

“Even those who like the NHS have to accept that it does have some very strange intellectual underpinnings.

It is curious how the existence of an alliance of statist Toryism and Socialism has fallen out of any popular consciousness. One of the few studies can be found in Semmel, B., (1960) Imperialism and State Reform: English Social-Imperial Thought, 1895-1914, Harvard University Press, Cambridge M.A. There is a growing literature on eugenics, ‘right wing’ (that is, anti-capitalist and anti-liberal) social Darwinism and paternalism. See: Searle, G. R, (1971) The Quest for National Efficiency, Oxford Universisty Press, Oxford and (1986) Social Hygiene in Twentieth Century Britain, Croom Helm, London. Soloway, R. A., (1990) Demography and Degeneration: Eugenics and the Declining Birthrate in Twentieth Century Britain, University of North Carolina Press, Chapel Hill. Some socialist scholars are also beginning to reconsider the origins and nature of the rise of the welfare state in light of such evidence. See: Skocpol, T., (1992) Protecting Soldiers and Mothers: The Political Origins of Social Policy in the United States, Belknap Press/Harvard University Press, Cambridge M.A. Jamieson, L., and Corr, H., (eds) (1990) State, Private Life and Political Change, Macmillan, London. Dwork, D., (1987) War is Good For Babies and Other Young Children, Tavistock Publications, London.

Under analysis, the origins of the welfare state looks less like the pure juice of human kindness and altruism, a liberation of the masses, and increasingly more like authoritarian social engineering for the sake of national strength, war or racial hygiene.”

Yesterday I was told something very strange. If it is true, then it is quite a coup. But so far, I simply don’t know.

Did you happen to notice that this Christmas there were fewer government drink driving adds on the television? I don’t always watch a lot of TV and I honestly don’t know about this. But, apparently, having written this and this I am advised that the government decided to do less preaching this Christmas.

Was it NFR? Was it that there is an election coming up and politicians don’t want to appear to be too nanny-ish? Were there really fewer drink driving adds on the box? I simply don’t know. You tell me. Is this true?

I was reminded of this quote again the other day. It is from Dr. Madsen Pirie and Dr. Eamonn Butlers’ report ‘The New Shape of Public Services’

“If a privatized health service had made many of its patients wait for 18 months for their operations, put them on trolleys in corridors when they arrived, given more than a quarter of them an illness which they did not have when they arrived, and confiscated the organs of their dead babies without bothering to seek their permission, or even to tell them, people would have blamed privatization. For that matter, if one of its practitioners had murdered 150 of his patients, or one of its surgeons had removed healthy kidneys instead of diseased ones, or one of its teams had conducted smear tests so incompetently that operable disease was not treated, while healthy women were unnecessarily subjected to distressing operations, all this would somehow have been put down to the reckless pursuit of profits, or to putting shareholders ahead of patients”.

One of the big stories in British politics over the last two years has been the way in which bloggers have progressively broken the all too cosy relationship between the lobby correspondents and the politicians. All too reliant on politicians for their stories, too many mainstream journalists ended up pulling their punches and failing the public. In opening up completely new avenues of information and discourse, the old guard of the BBC and the national press are slowly giving way to a new players such as Guido Fawkes who are increasingly becoming the key agenda setters. In the world of blogging and tweeting Westminster reporters could no longer sweep the expenses scandal under the carpet or fail to expose questionable political characters such as Damien McBride. No, the mainstream and established media are under real pressure now.

However, as in Westminster, UK healthcare journalists have for far too long also been guilty of the same sort of complicity. Reliant on politicians, civil servants, trade union leaders and other NHS types for their stories, very little real thinking or criticism has been leveled at the idea of state healthcare and socialised medicine. Indeed, most UK healthcare journalists are now so co-opted and ill-informed on the basic facts of health policy NFR believes they are setting themselves up for a fall.

In the last couple of weeks I have been interviewed by the Nursing Times and the Nursing Standard. I have talked to journalists on countless other health and professional publications. However, in all cases, I find that I am dealing with people who do not understand the basics.

Tell a UK health journalist that in America the US government now spends more on Medicaid, Medicare and S-Chip than the Pentagon does on the military and you will be met by uninformed disbelief. This, from journalists who believe that the US has a free market health system!

Tell a UK journalist that in Britain 7 million people have private medical insurance; 6 million have private health cash plans; 8 million pay annually for private complimentary treatments; that 200,000 self fund for surgery in private hospitals; that more than a quarter of people pay privately for their nursing and residential care home places, or that nearly 40 per cent of people are now going private for their dentistry and you will be greeted with the words “I had no idea about those numbers”.

Ask a UK journalist what they think about health savings accounts, or what health censorship is, how it came about in this country at the beginning of the twentieth century and why it might be bad for patients and you will hear “I no nothing about any of this”. Yet, these are the people who endlessly report that patients ‘lack information’!

Now, I like journalists and some of them ‘are my best friends’. Charlotte Santry of the Nursing Times was charming on the phone and I very much hope we will stay in touch. But all too often they are lazy, ill informed and unquestioning. Often unconsciously co-opted by old myths and elite interests they, like their friends in Westminster, will surely loose ground in the more competitive age of open communications.

For NFR, UK health journalism is due a good hard kick up the bottom. The idea that the NHS is great and that America somehow represents a free market is a non-starter when you know your subject. We can and we will do better than this.

With Republican Scott Brown having won a landslide victory for the Massachusetts US Senate seat previously held by Democrat Edward Kennedy, NFR smells blood on Obamacare. Thankfully, this nightmarishly statist policy is mobilising American voters as never before. Therefore, it is ironic that while Obama’s personal ratings continue to ride high, it is his policies that Americans simply do not want. They will not accept even more government healthcare.

Beyond the government programs of Medicaid, Medicare and S-Chip (which already have a combined budget greater than that of the Pentagon), Americans are not prepared to accept a trillion dollar programme designed by ideologues who want to further stifle what little remains of a market, so that they can then claim ‘market failure’ and make subsequent calls for full blown nationalisation.

While NFR disagrees with the statist politics of most US Republicans as much as it dislikes the Democrats (both camps implicitly accept largely overlapping degrees of Conservative big-government corporatism), when it comes to the global struggle to get the state out of healthcare, Scott Brown’s victory is good news. In bloodying the nose of his opponents, NFR can only hope that Obamacare will fall to dust. If this happens, instead of more government, it will be vital that thinking Americans capture the word ‘reform’ and make it their own. This is the key challenge for the future. Reform in American healthcare must come to be progressively associated with the market not the coercive state.

Since the recent meeting with David Cameron Nurses for Reform has attracted a vast amount of media attention. Perhaps most importantly we have also picked up lots of new support from registered nurses who have decided to formally sign up and support the organisation. Appalled by the horrific realities of state run healthcare many nurses have clearly been relieved to finally find an organisation that spells out some home truths about the NHS and campaigns to put the long term interests of patients first.

On the media front, NFR has been reported in The Daily Telegraph.  We have also been reported in The Mirror, here, here and here .  And we have been reported on major UK political blogs – such as Samizdata and the Adam Smith Institute .

There have been numerous other blogs about the organisation – including Liberal Conspiracy, Labourlist , and Tom Harris MP’s blog (to detail just a few) – and early this week I was interviewed by the Nursing Standard (readers will be able to see the result of this when the NS gets around to publishing it in a few weeks).

The really heartening thing about this episode is the dozens of nurses who have signed up to support NFR and what we stand for. Their emails and messages of support characteristically represent a profession who are tired of being gagged by politicians and misrepresented by the usual political class types at Unison and the Royal College of Nursing.

On the down side, NFR is mindful that many people in the UK and Europe still do not get how hostile the organisation is to American state healthcare. In failing to understand that the US government spends more on Medicare, Medicaid and S-Chip than the Pentagon spends on the military, it would be helpful if some of our detractors at least read this NFR article on why America does not have a free market healthcare system and therefore why NFR is hostile to the American healthcare system.

I am pleased to confirm that earlier this week I had an interesting hour with Tory leader David Cameron in his private office in the House of Commons. I had been invited by him to discuss NFR’s ideas on the future of health policy and presented a range of ideas. Amongst others, these included the end of national collective pay bargaining for nurses and doctors, the view that the state should not own or have any of its agents manage hospitals, a world of widespread health advertising (to overcome problems of patient ignorance through trusted brands) and a dramatic liberalisation of hospital planning laws. On this latter point, central government should have no say in when and where any hospital is opened or closed. If he becomes Prime Minister I have no doubt NFR will meet with him and his policy team again. But whatever happens, he can rest assured that NFR will remain very much on the outside of his – and any other party political – tent. As a libertarian organisation, NFR has a profound mistrust of all politicians. As such, we will remain dangerous and continue to think the unthinkable.

Even the fiercest critic of the NHS would have thought that the system could manage to teach doctors to prescribe medicines safely.  Apparently not according to new research from the British Pharmacological Society.  This study has found that not only is the training so inadequate that medical students only fill in a hand full of prescriptions, but when they qualify up to 10% of the prescriptions that write are incorrect and potentially life threatening.  You really could not make this up!