There is a wide belief amongst doctors that altruism is important to the concept of medical professionalism. There is also a view that new contracts introduced by the government for both consultants and GPs make delivering the altruistic element of medical practice more difficult. Dr Grumble is not sure that he agrees. But that is not the point of this post.
The point of this post arises from something Dr Grumble heard on the radio on his way to work. There was talk of the government's new ways of paying hospitals failing to cover the costs of some of the best work. A particular operation was the example. But this has always been the case for NHS hospitals. We have always robbed Peter to pay Paul. We have traditionally never said that we cannot do a particularly expensive but essential treatment because we will make a loss. That has not been the way. The NHS hospital is an altruistic organisation. It does its best to balance its books overall but it is happy to make a loss on some things. In the past, when it was essential, hospitals even used to make an overall loss. It was forced on them by clinical need. The price was paid to ensure that patients got the treatment they needed. The accountants had to sort it out later. That was altrusim.
Private organisations will not do that. Not to the same extent anyway. They might gain on a few swings and lose on some roundabouts but that's as far as it will go. But the altruism of the traditional NHS organisation is quickly being lost in the headlong rush for privatisation. How can you have an NHS organisation that is altruistic competing with a private organisation that is not? The NHS organisation will not be perceived as caring and altruistic but will be branded as ineffective and inefficient. And that, of course, is the reason why this got on the radio this morning. Because if we do not sort this out not only will the private organisation not give the loss making treatment but the NHS organisation won't be able to either.
Wouldn't it have been better if we had just kept the NHS altruistic organisations we used to have? What sort of government is mad enough to eradicate altruism from individual doctors and hospitals? Sadly, that government is ours.
26 August 2008