Monday, August 29, 2011

Beneficence & Modern Tyranny: Rights & Wrongs!!!

It is interesting to look back at what I have blogged about as we get close to decision time for our NHS Reform. Or was it theirs?

I think I and others had it wrong. We have assumed that those in power wants us to have choice in Health Care and decided that Competition is the way forward. 

Beneficence in the House M.D. style!

Am I really so naive!!! Do I really believe in what they claim they want to do: to do good for patients?

DrRich in his response to one of my blogs (and he used it for a few prominent lectures) talked about Beneficence & Modern Tyranny in relationship to Health Care and patients' rights and autonomy: 

When our founders ... found that individuals could not rely on any earthly authority to protect them, their life and limb, or their individual prerogatives. Mankind had tried every variety of authority - kings, clergy, heroes and philosophers - and individuals were eventually trampled under by them all. For this reason our founders declared individual liberty to be the bedrock of our new culture - because everything else had been tried, and had failed. In the spirit of the enlightenment they agreed to try something new.
…… Autonomous individuals often fail - either because of inherent personal limitations, bad decisions, or bad luck.

Modern Tyranny:
Those of us who defend the principle of individual autonomy - and the economic system of capitalism that flows from it - all too often forget where it came from, and DrRich believes this is why it can be so difficult to defend it. We - and our founders - did not adopt it as the peak of all human thought, but for the very practical reason that ceding ultimate authority to any other entity, sooner or later, guarantees tyranny. This was true in 1776, and after observing the numerous experiments in socialism we have seen around the world over the past century, is even more true today.

In NHS Reform: Disingenuous Government!!!

10.32am: Dr Clive Peedell, an influential and unashamedly pro state-run NHS member of the British Medical Council, has emailed with a statement as co-chair NHS Consultants Association. Dr Peedell, a consultant oncologist, says that the government is being disingenuous in its response to the Future Forum:

The government says
We will outlaw any policy to increase the market share of any particular sector of provider. This will prevent current or future Ministers, the NHS Commissioning Board or Monitor from having a deliberate policy of encouraging the growth of the private sector over existing state providers –or vice versa. What matters is the quality of care, not the ownership model.

This statement is disguised as a control on privatisation, but note "or vice versa". This means the revised bill will outlaw the Government now, or in the future, from naming the NHS as preferred provider.

The terminology of the NHS as preferred provider implies a deliberate attempt to encourage NHS public provision, so this policy will be outlawed (by legislation if the bill passes). However, the key point is that the policy of "Any qualified/willing provider" does not explicitly encourage
private sector provision per se (although it is obvious that this is what it is designed to do.)

As long as Government policy is not seen to deliberately and directly encourage private sector provision, the market share will be allowed to change. In fact, the decisions to involve private companies will actually be made locally by the clinical commissioning groups. This is therefore local decision making and not Government policy itself. So increasing NHS privatisation is still clearly on the agenda and the idea of the NHS being the preferred provider with be confined to the dustbin of history.

Peedell said in 2009:
Those in favour of the market-based approach believe that competition and contestability between healthcare providers will increase the efficiency, quality, responsiveness, accountability and equity of healthcare, by creating an environment where only the best organisations survive. However, there is a lack of evidence to substantiate these claims. Most of the available evidence suggests that market-based healthcare systems are poor value for money and deliver worse care to the populations they serve.

Thinking back to DrRich, we indeed cannot assume that government really wanted good care for its people!!!

No! No! No! 

Now it is beginning to make sense to simple folks like me. I have been judging them from a doctor's point of view: that they like us or most of us wanted to do good. 

I must now be careful not to adopt Dr House's paternalistic view on NHS Reform:  House MD

Perhaps, he suggests, for the many viewers drawn to this arch paternalist, there is something refreshing about a doctor willing to risk all—job, reputation and legal suits—in order to fulfill his duty of care to his patients: the duty to take care that his actions or inaction do not harm his patients. Because, for good or for bad, once you’re House’s patient there is nothing he won’t do, no inaction he will tolerate, if he believes that by failing to act he will harm you.”

Politicians are not House, remember?

Related: House M.D.: Modern Tyranny

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