NHS Cares More About Saving Itself Than Patients
According to Telegraph columnist Sherelle Jacobs, the exhortation to “protect the NHS” during the Covid emergency was not a one-off. The inversion of reality – whereby we must serve the NHS, instead of the NHS serving us – is a feature of the system, not a bug. Here’s how her piece begins.
It’s not even winter and already health chiefs are planning to beg the public to stay away from A&Es to relieve pressure on hospitals. Patients’ lives are being put at risk as they are urged to call NHS 111 instead – and kept on hold for 20 times longer than is standard.
This is all ominously reminiscent of lockdown. As it turns out, even back then the NHS never came close to being overwhelmed. Yet people dutifully stayed at home to save it from collapse – with many not seeking medical attention for non-Covid illnesses like cancer. The public is still paying the price, some with their lives, due to the resulting backlog.
One might have hoped that this would be a tragic one-off. After all, the NHS took the extreme measures that it did in the face of a mysterious new virus. But the way things are going, seasonal shut-downs of varying degrees could become the new normal – with public campaigns that urge people to stay away from hospitals, patients permanently unable to see GPs in person, and cancelled operations stretching endlessly into the future.
Even though the Government has committed billions of pounds in extra funding, the health service remains barely able to function. It is stuck in a vicious cycle, whereby it must routinely insure itself against a worst-case-scenario collapse by driving patients away. This, of course, only leads to more late-diagnosed cancer patients and more delays in routine treatments and operations, making the backlog even worse. Although the chances of an NHS “Black Wednesday” remain remote, in this era of close managerial surveillance and media scrutiny, such a prospect haunts its senior ranks.
Such a devastating doom loop has been a long time coming. The NHS has over the years devised countless strategies for keeping non-urgent patients out of hospital – from experimenting with “virtual wards” to half-baked schemes to revive family doctors. Appeals for patients to avoid A&E are nothing new, either, even if in previous years these were less frequent and more local. The bottom line is that, for years, the NHS’s primary strategy has been to reduce the burden that patients put on it, rather than to improve its capacity to treat them.
There is a structural reason for this. Our health service is idolised as open and equitable, free at the point of use to anyone in need. But in fact, it operates as a “closed” bureaucratic system. Like all such systems, it is absorbed with its own survival, which it seeks to achieve by minimising patient interactions. It avoids direct engagement with outside reality, instead conceiving the latter in a way that suits its own agenda – in this instance, re-imagining patients as its loyal servants, rather than as patients.
Such survival tactics are a necessary feature of all living systems (known in biology as autopoiesis, or self-creation). They are discernible in virtually all large bureaucracies and corporations, as observed by the systems theorist Niklas Luhmann. But the consequences in healthcare are alarming. Even though it is staffed with many dedicated and altruistic people, the NHS operates as a selfish organism. Its primary aims are to survive and self-replicate (particularly within its managerial ranks) – not to meet the needs of the public.
Worth reading in full.
