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The Core Option

Posted by Dr No on 11 May 2014

apple.jpgWriting in the Guardian last week, Simon Jenkins had a Big Idea, that small is best. Correctly concluding that central political meddling in the NHS has failed, he opted for the nuclear option. The core of his idea, which like the core of an apple had both rough bits and voids in it, but sadly unlike an apple no seeds, was that, since every other conceivable option has been tried and seen to fail, that left but one course of action: the NHS must be broken up. In prose that crashed about like a driverless juggernaut, the final jack-knifing when it came was curiously more hanging whimper than decisive bang: ‘Denationalisation is now the only version of a public health service not tried’. One fancies a Churchill bell may have been tolling in Jenko’s head. ‘It has been said that democracy is the worst form of government except all the others that have been tried’…‘denationalisation is the best arrangement except all the others not tried’ (sic).

The notion that an option has merit solely because it has not been tried is certainly novel. One notes, as others have done, that the National Trust, currently under Jenko’s stewardship, must also be ripe for nuking, on the grounds that denationalisation is now the only version of a national trust not tried (sic). Indeed, once one grasps the not tried nettle, enormous opportunities arise. Denationalisation is now the only version of our armed services not tried (sic), so why not set about nuking them too? Even Westminster might be ripe for nuking, on the grounds that denationalisation – despite some tawdry attempts in recent years, and a certain Scottish vote due later this year – is now the only version of government not tried (sic).

That denationalised versions of these institutions have not been tried is of course bunkum. All of these national institutions existed in denationalised form before being nationalised. Our health service before National Insurance and the formation of the NHS was denationalised. Denationalised landed gents struggled to maintain their stately piles before the National Trust came to their aid. Even the services existed as denationalised privateers and militia before the birth of our national armed services. And, before the various acts of union, each country of the United Kingdom ran its own affairs. Far from being not tried, all of these now national institutions have been tried, sometimes indeed very tried, as denationalised ones.

And yet, for some reason, our forebears saw fit to nationalise them. One supposes they might have been hooked on Jenko’s logic – nationalisation is now the only version of a health service/armed service etc not tried, so let’s nationalise them – but equally we might suppose that they took such draconian steps for other, less vacuous reasons. We might have a national health service, national armed services, even national government - even a National Trust - for the simple, and more importantly sound, reason that it makes sense to run such national services on a national scale.

Denationalisation is the apple in the NHS privateers’ eyes, and Jenko’s Guardian article is the latest shinning example. No national service run on a national scale will, because of its size, ever be perfect - take the current army scandal about trophy photos, or the BBC sex scandals - but by and large, these institutions work best as national rather than fragmented ones. Those who wish to bite Jenko’s apple would do well to recall that apples have since time immemorial had a habit of causing trouble. This particular apple, as Dr No suggested earlier, appears of have a core of rough bits and voids, but sadly no seeds.

1 comment:

The concepts of health and disease and their evolution over the centuries, the history of hospitals and health care organization, advances in science and medical research, the changes faced by the medical profession, his relations with the increasing complexity of society contemporary achievements of ethics and bioethics, the comparison with alternative medicine.

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