(ENT Staff hard at work, Manhattan)
Posted on 12/15/1990 1:42:00 AM PST by dighton
EVERY doctor receives a large, and growing, number of free publications of varying degrees of usefulness. Undoubtedly the least useful - that is to say, the most completely useless - is the NHS Magazine, a patronising glossy compilation, entirely devoid of worthwhile informational content, upon which the Department of Health has seen fit to waste £900,000 of taxpayers' money.
The magazine is pure propaganda, of course: spin made print. The NHS of the eponymous magazine is a land in which all faces are smiling, in which everyone looks forward to a glorious and untroubled future, in which the plan will be fulfilled and overfulfilled through the sheer Stakhanovite enthusiasm of the workers. Patients are called customers. There are articles about such vital matters as "the thinking behind the adoption of a single corporate logo to represent the whole of the NHS". One is reminded of Soviet propaganda of the famine era, in which tables groaned with food, there were endless fields of flourishing grain, and all peasants danced happily in embroidered national costumes, while millions in fact died.
The point of such propaganda is not to persuade, much less to inform: it is to humiliate and to render docile. The more at variance the tenor of the propaganda is with everyday reality, the more impotent the recipient feels, and the more firmly in the grip of a giant organisation against which all resistance is futile. Thus, when I receive my copy, telling me about the glories of information technology to come, of the mounting enthusiasm of everyone for the latest round of reforms, and so on, I know that a few yards up the corridor there will be elderly patients who have been waiting on trolleys in the corridors (renamed beds to improve the statistics for waiting times) for 18 hours, and that this has been going on, with fluctuations, for the past quarter of a century at least. But in the face of an apparatus of centrally organised lies, what can a mere individual do? He puts his head down and gets on with things as best he can, and thus poses no threat to the powers that be and that wish to be for ever and ever, amen.
The existence of the NHS Magazine is all the more galling since its appearance was almost simultaneous with the suppression by the Department of Health of the Prescribers' Journal. This little publication was highly esteemed by all doctors in Britain. Run by a committee composed mostly of eminent physicians who were unpaid and worked pro bono publico, it commissioned independent (and virtually unpaid) articles by the greatest authorities in the land on drugs and various medical procedures, providing extremely useful, up-to-date and unbiased summaries for doctors. The Prescribers' Journal cost about a third of what the NHS Magazine costs (£326,000 in its last year of publication). Much of this trifling cost was postage, since it was sent to every doctor in the land.
Why, then, was it suppressed? The official reason was that it was old-fashioned and that it contained no information unobtainable elsewhere, a reason that might justify the suppression of almost any publication whatsoever that contained anything other than original research. Moreover, it simply wasn't true that the Prescribers' Journal contained information easily obtainable elsewhere: it was of precisely the kind that a busy doctor might need but experience difficulty in finding. For example, it ran a useful series on the various routes of drug administration, with their advantages and complications: information that is far from easy to collate, but is none the less extremely important for doctors to know. A doctor who read the Prescribers' Journal assiduously would be very well informed: a doctor who read the NHS Magazine would be simultaneously bored and angered. It certainly makes me apoplectic with rage, and did so even before I knew that it has so far attracted 22 paying subscribers.
The Prescribers' Journal was suppressed because it was genuinely independent. A survey demonstrated that fewer than one per cent of doctors thought it was the mouthpiece of the Department of Health, a situation that no self-respecting apparatchik like Alan Milburn could be expected to tolerate for long. It would be like having a BBC that advertised for staff anywhere other than in the Guardian.
The Prescribers' Journal was in potential conflict with the deliberations of the National Institute for Clinical Excellence (by excellence, of course, is meant uniformity), which is expected increasingly to boss doctors about and make them criminally liable if they reject Nice's advice. Being genuinely independent and disinterested, there was a distinct possibility that the experts recruited by the journal might come to different conclusions from Nice's, and in our new gloriously diverse and multicultural Britain, we must all sing the same song with the same voice. Indeed, in the last days of the journal's distinguished existence, pressure was put on its editors not to publish on certain subjects for fear that its conclusions might differ from Nice's. For is it not evident that any question in medicine must have one, and only one, indubitably correct answer, revealed to Pope Milburn the First?
To change the analogy slightly, the Department of Health is acting like a (so far) mildly fascist organisation, and not for nothing did a doctor write to one of the former editors of the journal, calling the suppression of the publication an example of the Government's policy of Gleichschaltung, of gathering together and imposing uniformity under central control.
As the NHS Magazine demonstrates, the way forward - as far as the Government is concerned - is not to change reality, but to change the presentation of reality. If only publications can be made glossy enough, with enough multicoloured photographs, then it doesn't really matter much what has happened, happens and will continue to happen a few yards up the corridor from my office. We live in a virtual world, in which - it is supposed - most of the people can be fooled most of the time. But a trolley is still a trolley and not a bed.
© Copyright of Telegraph Group Limited 2001.
Found it in "Interview with Tatiana Fedorova, Soviet Construction Worker"
Q: You led a team of Stakhanovites when you were building the metro. What did that mean?
Fedorova: There were a lot of leaders in the Stakhan movement; a movement of workers which took over the whole country. In the Moscow metro building, of course, everyone wanted to be a Stakhanovite. I led a team who worked really brilliantly under the ground. Then we would go forty kilometers away and do parachute jumps. It was a wonderful happy life, full of enthusiasm.
Q: What good did the Stakhanovite movement do for the Soviet Union?
Fedorova: It was a movement that wasn't organized by anyone in particular. It was started by a working man, who I knew very well, and everyone in the country who knew him started it. He studied the very best methods of working in mines and then learned the technical side of it. Stakhanovite produced this fantastic speed record and then, literally, in all aspects of the economy and in all branches of the Moscow metro building, whether you were working with concrete or not, everyone wanted to achieve the highest speed. It was, economically and spiritually, a very big thing for the country.
Q: Wasn't it really just a method of trying to get workers to work harder?
Fedorova: No. No one forced us to do it. We didn't have to do it, but everyone wanted to... It's very hard to explain but it was the time of the enthusiasts. At that time Mayakovsky said that communism is the young people of the world and we were the young people of those years. Each of us tried to build a foundation of the structures with great joy. It was like a happy song.
"How is the NHS funded?
The NHS is free at the point of delivery to anyone normally resident in Britain. All taxpayers, employers and employees contribute to this cost.
About 82 per cent of the cost of the health service is paid for by general taxes.
The rest comes from:
A proportion of National Insurance contributions (paid by working people and employers) - 12.2 per cent
Charges towards the cost of certain items, such as drugs prescribed by GPs, dental treatment and sight tests - 2.3 per cent. (Children and adults who may have difficulties paying are exempted from these charges)
Land sales and other schemes for generating income - less than one per cent
In addition:
health authorities are free to raise funds from voluntary sources
some NHS hospitals take private patients who pay the full cost of their accommodation and treatment"
There's the rub. It is that "standard" that is the difference, I think. Paying for health insurance via employers' plans via payroll deduction is not very expensive and the choice to seek the best is always there. Those not able to afford health insurance or those too poor to afford doctors' fees can always get free care in the US.
There are several humanitarian and religious organizations that would have helped. In lieu of that, this book would have been a good resource.
Luckily, the teacher was there for consultation. That's part of an MD's education, sort of like practice teaching. It's not the optimal situation, but it's rare when we find ourselves in that comfortable place.
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