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Paul T Horgan: The NHS is run like the Soviet Union and performs like it

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One of the numerous characteristics of collectivist ideology is the concept of a historic inevitability of the rise of communism. Socialism is brought about, wrote Marx in Capital, by the “operation of the immanent laws of capitalistic production itself”. The result of this is that every time there is a ‘crisis of capitalism’, this is regarded as heralding a Marxist revolution.

Of course, this is complete rubbish. The sustaining feature of capitalism is that it weathers and transcends periodic crises by reinventing and improving itself through technological and social progress. The constant feature of socialism is the historic inevitability of stagnation and collapse as a demotivated population simply stops working to the best of their ability as all incentives to do so are criminalised. 

The NHS in England seems to be going down the same path as the USSR, despite having ring-fenced income guaranteed by a Conservative government. In Labour-controlled Wales, the situation is so desperate that there is an influx of Welsh health refugees flocking across the border to seek help. There is also the issue of the unprecedented industrial action by junior doctors. What is going on?

The knee-jerk reaction is to blame the Conservatives for mismanagement. But this is to attack incumbency. There is no evidence that a change of government would improve matters. The Mid-Staffs scandal took place on Labour’s watch.

The NHS has a structural problem in that it is increasingly unable to function, but this is not the fault of any government. It is because of the contradictions of its existence. It is required to provide a universal and free service. However there is no limit on the entitlement to that service. If a service is to be universal and free, entitlement has to be controlled or the service will be unable to cope with unpredicted demand. In an era of low immigration, like the late 1940s when the NHS was set up, this was possible. It is not possible now.

The NHS cannot adapt to the surge in population that the UK is experiencing as a result of open-door immigration. There is no indication that NHS services have actually been planned for such population increases. Being a service run on socialist principles, supply is designed to precisely match demand, as is always done in socialist economies. The planning is always faulty in these cases and the consequence is shortages. The NHS, being run like the USSR, is functioning like the USSR. 

The second issue is universality. The range of treatable conditions has grown enormously since the NHS was created. The information used by Labour politicians to design the NHS is well out of date. The DNA molecule had not even been determined when the NHS was created. The diagnosis and treatability of cancer was thus limited by modern standards. 

Atlee and Bevan were not thinking of a service that would be offering free sex-change operations and the life-long aftercare associated with it when they created the NHS. ‘Nowadays, officials have to choose between funding elective adult genital sculpturing or premature babies’ incubators.  It is unlikely Nye Bevan considered a concept like the provision of prophylactic drugs for sexually active homosexual males to prevent HIV infection. Would Atlee have approved of a morning-after pill?

Growth in funding is being absorbed by growth in new services. This would happen irrespective of whoever is in charge. It is therefore reasonable that with new information, there should be new approaches. Junior doctors are striking because of a conservatism in the face of necessary progress. They also want more money.

The NHS is a persistent relic of the Atlee years. People forget that despite the creation of the NHS, the electorate savagely cut down Atlee’s landslide 1945 victory to a majority of five in 1950 and kicked him out of No 10 a year later. Even two years after the creation of the NHS, the British people did not rate this as enough to keep voting Labour.

Part of the problems experienced by the NHS are due to its politicisation. It is not well known that every party went into the 1945 general election promising to create an NHS. It was only Labour that offered a monolithic. Uncompetitive, non-contributory, heavily unionised, centrally planned organisation and bribed voters with their own money. Bevan concealed the true cost of the NHS from Labour’s Chancellor, Hugh Gaitskell. Without a loan from the USA, the NHS could not have come into existence as Labour could not have afforded it.

The NHS is experiencing the historic inevitability of a crisis of socialism. There has to be radical change in its structure to face unpredicted challenges. A monolithic, exclusively taxpayer-funded, centrally planned service cannot adapt. People have to recognise that and be prepared to say goodbye to the NHS as its modern, progressive successors are created.

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Paul T Horgan
Paul T Horgan works in the IT Sector. He lives in Berkshire.

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