Those horrednous stories...

I refer to the stories of appalling treatment received by thousands of (mostly elderly) NHS patients in hospital.

The vast majority of us when we visit hospital receive perfectly adequate treatment if not very good treatment. Do other countries experience these minority problems? The answer is yes, and they were mostly in countries under socialism which have now improved with the replacement of socialism.

So, while we have never had a fully socialist state here, does the NHS show some characteristics as a socialised enterprise?

In two respects, yes.

1) There is little alternative for patients, unless they are wealthy. There is little choice. The service is a monopoly with no threats against poor performance. The vast majority of nurses and doctors are unaffected by this, but the small minority, especially those resentful of being overworked and unappreciated, are.

2) Finance is limited, cut-backs are constantly been made in response to directives from Whitehall. Posts have been frozen. There are staff shortages, caused by and causing the very high periods off work which we read about recently.

There are other factors.

Many of those who experienced the poor treatment were elderly, confused, frightened and perhaps unable to plead their own cases. In addition there could be problems of incontinence, not the most attractive duties for nurses now all graduate, given increasing responsibilities, and involved in the high technology aspects of health care. Geriatric wards probably suffer from financial cutbacks and staff shortages.

There is little doubt that nurses increasingly find much of their time is used to update, log and report writing. They have to join in the unending provision of statistics to be reported to PCT and higher. In this respect they are like the police, who spend large parts of their time on admin.

There can be no doubt that if there were genuine "competition" and real choice by patients, we would have a relatively cheap way of outlawing bad treatment. Reports would be out, and doctors and patients would avoid the situations of poor care. Under-use in the departments concerned would threaten staff, or at least lead to internal review and improvement.

In no other area of life, except the BBC, again a large monopoly in many respects, would poor service not be followed by a lack of demand and a consequent need to improve. In no other area is there always a temptation to offer a"take it or leave it" service.