THE NHS: A CRISIS OF FALSE EXPECTATIONS
British Prime Minister Tony Blair was driven to defend health worker and the National Health Service (NHS) against unwarranted attacks, after the leader of the Conservative opposition, Ian Duncan Smith raised the case of Rose Addis, left unwashed in an Accident and Emergency Department for two days.
Much has been made of the high-risk strategy of the politicians trading blows over the specifics of the case - high risk for them, in case they prove to be wrong, and high-risk for patients, made into a political football. Health care professionals could be forgiven for demanding that the politicians stop trading blows over the NHS, and put their heads together to come up with solutions. Certainly the current debate over health care takes so much that is confused or just wrong for granted that it is unlikely to lead to a practical result. There is however a real problem at stake, even if neither political party is capable of dealing with it.
Tony Blair's fulsome defence of the health service should be seen as an attempt to redirect a policy that has developed under his government - the policy of opening the taps of public dissatisfaction as a means to impose discipline upon the intractable health service bureaucracy.
A number of high profile campaigns have sought to highlight what are seen as shortcomings in the system. At Alder Hey hospital in Liverpool parents attacked doctors for using embryos for research; other hospitals have been targeted for success rates. The campaigns are an indication of a different mood towards the publicly funded health system. Where once the NHS was a trusted institution, today patients and relatives increasingly approach the health service with the expectation that they are being cheated at best, and put at risk of permanent injury or death at worst.
The loss of respect for the health service is relatively unrelated to the quality of care. Instead it tells us a great deal about the contemporary social mood, in which public institutions in general are viewed with disdain verging on outright hostility. Worse still, doctors and nurses' own lack of confidence about their authority has given rise to a number of directives that - though intended to demonstrate responsiveness to public fears - only serve to further undermine people's trust for the service. Patients continually badgered by doctors nervous questions about whether the treatment meets the patient's needs are not likely to be impressed with the doctor's authority.
Having sought to ride the public anxiety over health provision, the Blair government finds it necessary to rein it in. In a gruesome reaction, Blair repeated the Whittington Hospital's charge that Rose Addis had refused treatment from black nurses. Mrs Addis' granddaughter wrote to the papers denying that her grandmother was prejudiced, but more to the point that even those who are not politically correct are entitled to health care. Unfortunately she is wrong. The NHS has announced new guidelines for refusing assistance to those who exhibit racial prejudice. Coming after the refusal to treat smoking patients, the new race guidelines indicate that moralistic distinctions will play a greater role in future health-care rationing.
Patients are understandably bemused. On the one hand they are encouraged to adopt a militant attitude towards the service, but when they do, they stand the chance of being pilloried in the press. Presumably the Alder Hey parents are not to be denounced for their catholic prejudices against embryology, but then who knows?
ENRON
The suicide of the former Enron director underlies the scandal over the firm that symbolised the power industry's backing for President Bush. Enron's overexposure to risk came as a result of its transformation from Oil Company to trader in energy futures, a speculative venture associated with the US electricity companies' confusing internal market.
More damaging, the probity of the top draw accountancy firm Andersen has been called into question, as they regularly signed off Enron's supposedly healthy balance sheet, without noticing or at least not drawing attention to the problems of its indebted subsidiaries.
Already Enron's collapse has provoked calls for greater regulation of the relations between accounting firms and their clients. The apparent conflict of interests as accountants prefer not to damage the people that pay them seems to make a case for special oversight of the industry.
Manufacturing firms have increasingly shifted into financial markets, with many making more from their investment arms than their original business. The growing trend towards integrating the speculative financial side of American capitalism and its manufacturing base, is not challenged but consolidated and legitimised by increased government regulation. -- James Heartfield Sustaining Architecture in the Anti-Machine Age is available at GBP19.99, plus GBP3.26 p&p from Publications, audacity.org, 8 College Close, Hackney, London, E9 6ER. Make cheques payable to 'Audacity Ltd'. www.audacity.org