A universally respected consultant who recently retired from my hospital came to me and lamented that, when he first arrived at the hospital, there were 1,800 beds and three administrators, but now there were three beds and 1,800 administrators. An exaggeration, naturally, but there can hardly be a doctor or nurse working in the National Health Service who would not know what he meant. The atmosphere in the NHS has changed beyond all recognition in the past two decades. Whether or not you approve of the founding principles of the service, you can only conclude that it has been irremediably corrupted by successive governments, starting with Margaret Thatcher's and accelerating with Tony Blair's. What began as reform has become permanent revolution, with successive secretaries of state playing the role of Trotsky. The constant effervescence of reorganisation keeps the workforce not so much on its toes as in deep despair.
Although I disagree strongly with her fundamental political philosophy, I agree with much of what Allyson Pollock, professor of health policy at University College London, writes in this book. Furthermore, I admire her prose, which is direct, muscular and entirely jargon-free. I would give no hospital administrator a job until he or she had, as a matter of habit, learned to write as clearly as Pollock writes.
Remorselessly, she lays bare some of the idiocies to which the NHS (and, by extension, the whole of the British public service) has been subjected. If it is the case that treatment in the NHS has improved greatly during this period, then this is almost entirely the result of technical advances pioneered by doctors and scientists, and owes nothing to the efforts of successive governments. I suspect that, had the NHS not undergone any reform, it would have worked far better than it does today, and probably be much cheaper into the bargain.
The current malaise started with the concept of general management, introduced by the witless Griffiths report of 1983. Sir Roy Griffiths did more than any other person, in the name of efficiency and cost-cutting, to corrupt the British public service. The misuse of funds by public service administrative staff is now endemic. Almost single-handedly, Griffiths brought into being a large cadre of people with a vested interest in perpetual chaos and disorganisation, which habitually mistakes its own activity for work, and which regards any problem as a good reason to expand itself.
In the process, the NHS has been turned into one of the largest pork barrels in history. The boundaries between the permissible and the impermissible, the honest and the dishonest, the public and the private, have been eroded to the point of extinction, as an army of suppliers of services, dubious financiers, merchandisers and consultants (often former NHS staff) has been called into being. Corruption of the money-under-the-table variety would have been preferable.
I think Pollock is wrong to see what has happened as merely the takeover of the public sector by the private sector: it is more sinister than that. What we are experiencing is the creation of a truly corporate state, in which lucrative contracts are awarded to private companies and individuals on the basis of political criteria or contacts. If the government depends upon the support of private enterprise, private enterprise increasingly relies on the patronage of the government. Britain is fast becoming a Peronist state, with Diana as its Evita.
There is a certain lack of international perspective in this book. Britain, after all, does not stand alone. There is little doubt, for example, that the experience of being ill and hospitalised has long been more unpleasant in Britain than anywhere else in Europe, and this was the case well before Griffiths.
Nevertheless, NHS plc is an excellent guide, not only to the woes of the NHS but, by extension, to those of all the public services in Britain. It helps to explain why, in Britain, we can no longer even run a public examination system satisfactorily. It is a lamentable tale of private enterprise without enterprise, and of public expenditure without public purpose.
Theodore Dalrymple is a practising doctor
