Having recently retired from the National Health Service, I thought I might soon miss the work, particularly contact with patients. But I was recently sent a circular from the NHS trust by which I was formerly employed that reminds me how little I miss the increasing managerialism of the service. It succeeds in combining fatuity with a hint of menace.

The circular, signed by the "Improving Working Lives Lead Nurse", [...]

The hope of monetary compensation will worsen almost any medical symptoms. The deterioration usually occurs independently of the sufferer's will: it is an effect of which he or she is unaware. But sometimes, as any doctor who prepares medical reports for insurance companies knows, claims are entirely fraudulent, in the sense that the alleged sufferer is fully aware that his or her symptoms are not real. For example, a man [...]

It is a law of public administration that the more administrators there are, the more administration there is to be done. It is a further law that the more administrators there are, the less administration gets done: hence the need for increasing numbers of administrators.

I work in a new medical facility, built at a cost of several millions: no expense spared, except on vital necessities, on which the [...]

Everyone - everyone, that is, who is middle class, which is what counts in these matters - knows someone whose mysterious and refractory illness has finally yielded to the ministrations of homoeopathy: or if not homoeopathy, then to crystals, Hopi ear candles or aromatherapy. An age of hypochondriasis is also an age of miracles: and why should miracles be available only to those who can afford to pay for them?

Stapled to my hospital payslip each month is a glossy, expensively printed, eight-page propaganda leaflet from trust headquarters. In true Stalinist fashion, it portrays a happy and contented workforce, proud of being awarded stars by the government. There is always money enough for this kind of thing - though not for medical supplies, equipment, or staff salaries.

The leaflet's main value, though not its purpose, naturally, is to illustrate how [...]

The organisation that the National Health Service most resembles is the Bolivian navy. That formidable force has no ships and no outlet to the sea, but it has many admirals with splendid titles and uniforms. Doubtless they all become management consultants to the navy when they retire.

It was the annual report of the NHS trust for which I work that brought this analogy to mind. The report is glossy, [...]

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 [...]

Human rights, which are now so exciting both government and opposition, to say nothing of the lawyers, are funny things: there is nothing quite like them for making life wretched. The other day, in the prison in which I work, I discovered a man who, mentally disturbed, was making a terrible racket. He was singing at the top of his very loud voice, and he was banging on the door [...]

In the same week that David Blunkett, the Home Secretary, proposed that paedophiles be subjected to lie-detector tests, to discover whether they were still attracted to children, it was announced that pregnant girls under the age of 16 could have abortions performed upon them without the knowledge of their parents. Together, these symbolised in the starkest possible fashion the confusion that reigns in this country on the matter of child [...]

I recently had a patient whom I thought it right to admit to a psychiatric hospital. As he was privately insured, and as the local National Health Service institutions are noisy, overcrowded, dirty and dismal, I thought it in his interest to get him admitted to the local private hospital.

It was in my interest, too, not because I stood to make any money from it, but I hoped it [...]