The NHS? Beyond parody! And contempt!

Are those who decide our health policies "beyond parody and contempt?" No. They have tough choices to make. But so do private companies

Beyond parody and contempt?
Charles Crawford
On 13 July 2012 09:07

Last week I had some NHS. I went to a hospital in Oxford to have an MRI scan on my ankle, still not right after I wrecked it back in December by slipping on the ice in Nizhny Novgorod while attempting to observe the Russian Parliamentary elections. I was recommended by my GP for an MRI scan to look for tissue damage.

MRI machines contain massive heavy magnets and come in two sizes: large and expensive. So I lay there for some 30 minutes as the dismal ankle was scanned, then went on my way. The next day my GP telephoned and referred me to another hospital specialist. Today a letter has appeared offering me a further appointment at the hospital. Seems good enough?

After this procedure I talked to a friend who is an NHS hospital radiologist. He said that the problem with MRI machines was that smaller ones designed for legs were not likely to be used enough to justify the cost. Hospitals therefore bought large expensive machines to cope with any size of scan and used them at full tilt. Because they were so fantastic at showing what was going on inside a patient, there were more and more requests for MRI scans.

This, he said, created a problem with follow-up action. NHS targets could be met only by ‘managing’ waiting-lists. Previously hospital radiologists would themselves see what the scan said and refer patients on to the right hospital specialist. Now a decision had been taken to send all scan reports back to GPs who would decide what to do next.

GPs were not necessarily skilled enough to do this well. Some patients might suffer as a result. But the ploy would slow down the flow of patients from scans to follow-up hospital action and thereby allow NHS targets to be met! Hurrah!

So, you ask, what?

Over at the Financial Times John Kay bemoans the current state of Corporate Values, citing the infamous Ford Pinto car and its cost-benefit analysis of its potentially exploding fuel tank:

But they estimated that only 180 people would die, and if you value life at $200,000 per head (including $900 for funeral expenses and an extra $10,000 because burning to death at the roadside is pretty unpleasant), it is cheaper to let accidents happen.

The calculation is beyond parody or contempt. And yet while it is easy to say that safety, or human life, is priceless, in the real world trade-offs have to be made. Every cheap car could be made safer, but then it would cease to be a cheap car, and people who take a modest risk every time they leave the house (or, more dangerously still, stay at home) would not be able to benefit. But as soon as that calculation was disclosed, Ford’s case was lost

… we find unacceptable the instrumentality of making the calculation at all. We detest what it tells us about the values of the company.

John Kay concludes that the high-profile cases of corporate irresponsibility reflect a single mistake: these businesses each have raised “doubts about their values in the instrumental search for earnings”.

The annoying thing about this article despite its fair nod in favour of ‘real world trade-offs’ is that it fuels wider collectivist clamour against business and free enterprise.

Precisely the same criticisms can be leveled at the NHS for pursuing the policies I have described above.They are instrumentalising outcomes to suit the organisation’s financial purposes, trading risks to human life against money and convenience, just as Ford did.

In fact, each year, the NHS is deliberately allowing (if not directly causing) thousands of elderly patients to die who are quietly deemed not to have enough of a prospect of recovery and a reasonable added stretch life to justify further treatment. A private corporation behaving like that would be forced to shut down.

Wait! The NHS is not operating for profit or greed. That’s the difference!

What sort of difference is it really? In each case the issue is about the supposed financial value of human life.

And that argument cuts both ways. Taxpayers have money taken from them by force by the government (‘taxes’) to pay for health services, so they might think that they are entitled to be free from crude cost-benefit analyses, or at least have these calculations made explicit.

Private corporations by contrast sell their products only if people want to buy them. There is no element of compulsion. So if anything they should be held to lower standards of risk-management than public bodies: the markets can price in reputation or lack of it. Caveat emptor.

The basic point is simple. Every day all organisations big and small, public and private, need to weigh up costs against benefits. It’s the main thing any organisation does. 

Populist yahooing about moral lapses on the part of corporations - even in the FT which might be thought to operate to a higher intellectual standard - is primitive and harmful. It creates a climate in which people think even more stupidly about risk management than they otherwise might do, and encourages them to default to statist interpretations of risk that in fact are fatal to far more people.

The Ford motor company concluded - using statistical cost-benefit guidelines set up by national regulators - that if ‘only’ 180 people a year died because of exploding petrol tanks the cheaper design would be worth it. The NHS every week kills far more people than that through negligence or through rationing and other procedures that deny timely treatment to patients urgently needing it.

Does that mean that those who decide our health policies are “beyond parody and contempt”? No. They have to make tough choices. But so do private companies.

That’s not ‘unacceptable’ or ‘detestable’ or whatever other word you’ve found in the Thesaurus for expressing today’s example of synthetic chattering-class indignation. It’s essential. It’s what makes human progress possible.

Charles Crawford is a Contributing Editor to The Commentator. A former British Ambassador in Sarajevo, Belgrade and Warsaw, he is now a private consultant and writer: He tweets@charlescrawford

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