Magazine article The Spectator

Losing Patients

Magazine article The Spectator

Losing Patients

Article excerpt

The corruption of modern Britain is not a matter of money passed surreptitiously under the table; it is much worse and more serious than that. It is the corrosion of our very souls by managerialism that is turning Britain into a very corrupt little country indeed. Moral and intellectual corruption has not only been legalised; in some - perhaps many - cases, it has been made compulsory, a condition of continued employment.

In countries with a tradition of straightforward bribery, corruption may conduce to economic and administrative efficiency. This is so where regulation obstructs all useful activity, or would do so if the sword of subornation were not able to cut the Gordian knot of bureaucratic immobility. In countries with such a tradition of bribery, the bribed are expected to carry out their side of the bargain, if not for the sake of their own honour, at least for the sake of continuing the glorious and precious tradition.

Our kind of corruption, on the other hand, is not only compatible with inefficiency, inertia and incompetence; it actually promotes them. Moreover, by involving everyone in its snares, it ensures that no one is able to take a stand against it: for everyone is implicated, and none can point the finger. I remember a Romanian telling me, just before the downfall of the Ceausescus, that it would take three generations at least to remove the taint of the communist system from the souls of Romanians; it will take at least as long to remove managerialism from the souls of the British, though it has been with us for so comparatively short a period. It started under Mrs Thatcher - but that, as Mrs Hawksbee said, is another question.

The distortion of medical practice by managerialism is well established. A consultant at the Radcliffe Infirmary in Oxford told me recently that, in order to meet government targets with regard to the speed at which patients were examined medically and moved into hospital beds in the casualty department, ambulances bringing patients were not allowed to transport them through the hospital doors until such time as they could be seen within the specified period. As a result, of course, ambulances piled up outside the hospital, which was tough luck on those who needed an ambulance quickly; but they were only patients, and it's the targets that count.

Patients are being discharged from hospital not because they are fit to be discharged, and not because they beg to be allowed home, but because targets cannot be met if they are not so discharged. Kindness and decency are no longer permissible reasons for keeping someone in hospital; we must get them out, as the Americans say, 'quicker but sicker'. So what if they come back soon afterwards with the complications consequent upon too hasty a discharge? The original illness and the complication can be treated statistically as two episodes, thus increasing the efficiency (on paper, always on paper) of the hospital.

Sometimes, patients don't get as far as being discharged too early because they are not even admitted in the first place, when they quite clearly should be. I have seen patients who have been misdiagnosed with trivial or less serious complaints when they have serious and even life-threatening ones, not because the doctors are incompetent and don't know what they are doing, but because they are constantly working in conditions in which each new admission to hospital creates a crisis throughout the entire system. If a patient needs admission, the doctor feels terrible tension if no bed is available. …

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