Fat? Smoker? No surgery

fatsoFree medical care fails on all three counts: it’s not free and it’s about neither medicine nor care.

The state uses ‘free’ medical care as a justification for putting its foot down. The foot may come down with a big thud, as in Cuba, or furtively, as in Britain. But come down it will.

Those Cuban ingrates were prepared to risk their lives to escape free medical care. They’d rather be ripped off by those greedy US medics – really, there’s no pleasing some people. Alas in Britain we have nowhere to run.

The NHS has just approved plans to withhold non-urgent surgery for the overweight and smokers. This includes hip replacement, removal of tonsils and hernia, and other procedures that feel urgent enough to those who need them.

Someone ought to remind the NHS what medicine is for. Here’s the multiple choice:

a) teaching good behaviour, b) punishing bad behaviour, c) increasing the power of the state, d) treating the ill. If your answer is a), b), c) or all three, apply for a senior position with the NHS.

The logical inference is that the NHS doesn’t really need doctors, nurses or hospitals to achieve its principal goal, increasing state power.

It should cut out the middlemen (frontline medical staff and facilities) and employ only those who take the direct route to the desired destination: regulators, administrators and directors of diversity.

This is already happening without much fanfare: administrative staffs are mushrooming, hospitals or their departments are closing, the number of beds has gone down from a pre-NHS 400,000 to today’s 150,000 (although in the interim the population has grown by 20 per cent).

Yet so far this process has lacked an honest, forthright justification. This it has now been mercifully provided by Rachel Sylvester of The Times. I’ve never had the pleasure of meeting Miss Sylvester but, when I saw the title of her article (Closing Hospitals Can Help Us Save the NHS), I knew we’d get along just fine.

Here was a kindred spirit, someone who knows what the NHS is really for, I thought. Then I read the article and realised mournfully that we aren’t soul mates after all.

First, she doesn’t really understand the aetiology of the disease she set out to treat. “The financial problems facing hospital trusts are matched by a growing workforce gap,” she writes. In plainer words, hospitals don’t have enough money to hire enough qualified staff to treat patients.

Rather than pondering why this problem didn’t exist before the country was blessed with the arrival of the NHS, Miss Sylvester goes off on all sorts of tangential non sequiturs, justifying the derisory Russian quip about woman’s logic (something I emphatically and unequivocally disavow, I hasten to add).

A logical chain of thought would have some essential links: 1) We must have enough hospitals with enough staff to treat us; 2) Not having enough money to hire them isn’t an option; 3) The current system manifestly can’t satisfy this requirement; 4) Therefore the current system must be replaced with something known to work, such as the pre-1948 medical care in Britain.

Instead Miss Sylvester bemoans the high cost of hospital care (£400 a night), and states the blindingly obvious fact that “nobody seriously wants to spend more time than they have to in an institution where they are at risk of infection…”

That risk didn’t exist when our hospitals were run by two people, head doctor and matron, rather than by accountants and directors of diversity. Nor did the problem of finding enough qualified staff exist then – as it doesn’t exist anywhere else where socialism and medicine go their separate ways.

Other than that, her statement is one of those non sequiturs: it in no way denies that people should be able to stay in hospital for as long as it takes to get better. All this sets up the non sequitur to end all non sequiturs: her proposed solution.

Approaching the problem with the soldierly directness of Alexander the Great, Miss Sylvester proposes shutting down most hospitals and A&E units for lack of funds to pay qualified medics. Instead the few remaining medics should be concentrated in a few centres.

She cites Professor Naomi Fulop, who is an advocate of this system, as saying: “It may seem counterintuitive for an ambulance to drive a critical patient straight past the nearest hospital, but it saves lives.”

It won’t, dear, if this experiment is tried on a large scale. It’ll be a disaster. Even with A&E units operating at most hospitals, it now takes hours to be seen. Now imagine the logistic catastrophe of bleeding and apoplexic multitudes descending on the few centres in a city the size of London, where the average traffic speed is 9 mph.

Of course, when your turn comes, you’ll be seen by a medical ace, which is a comforting thought – if you don’t happen to be bleeding too fast.

Now I have a better solution: we should have enough local hospitals with enough qualified people to save lives. If the NHS can’t provide that, it’s not hospitals we should close down but the NHS.

Alas, this line of thought is impossible in a country where ‘free’ medical care is a religion, and the NHS its church. We don’t think about the NHS; we just worship it – all the way to disaster.

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