What you do not appreciate is not valued, and that which you do not value is soon lost.
Not the words of old Dr Grumble but the words of a junior doctor. But it is a point that worries Dr Grumble. Our government seems intent on undermining the NHS in the eyes of the public. Public expectations are being driven ever higher and nobody seems to realise, certainly not the government, that these are expectations that can never ever be met. Despite bankers demonstrating the catastrophic problems that can result from unfettered markets the government continues to see markets as the solution to the NHS. This can never be. Why the management gurus cannot grasp this escapes Dr Grumble. For them there will follow at the end of this post a little allegory which was stimulated by these words from a junior doctor which set Dr Grumble thinking:
The harridan with the woman then proceeded to say - really nastily - "I think we'll change the whole hospital next time. We won't come here again."
What do these people think the alternative is? Is there a Special Hospital around the corner where their trivial tax payments are magically converted into their own private physician, caterer, and a master of ceremonies who ensures things happen at the moment they snap their fingers?
The alternative hospital down the road is, of course, the model our government favours though, as the junior doctor plainly realises, it is not a realistic or sensible one. Shopping around for healthcare seems to be the government's panacea for each and every problem of the NHS. But shopping around is not what you do when you are ill. Shopping around is what you do when you go, say, food shopping with your own money. You can chose Waitrose or you can go for Asda. If someone else is paying it will be Waitrose. If you are paying it could be Asda but it might be Waitrose depending on how much you are prepared to spend. If somebody else is paying you will moan if they make you go to Asda.
It is a not such a strange thing that if you open the doors of either Waitrose or Asda and tell the customers that everything is going to be free there will be queues at the door and the shelves will soon be empty. Just imagine what happens in this idyllic world of the free supermarket. Inside the shop the underpaid shelfstackers work in a mad frenzy trying to keep the shelves full. But however hard the stackers work to ensure the shoppers have everything they need, the customers keep emptying the shelves. The shop is always thronging with people. It's difficult getting from one aisle to another. The shopping process is inefficient. Cleaners can't clean because the place is so full. This needs a management solution. So the managers limit the number of people allowed to come into the shop. Queues build up outside but people are prepared to wait for over six hours for something that is free. But that is the only way you can control demand. In any other shop you control demand but putting up the prices. But that can't be done in the mad world of the free supermarket.
But limiting demand by controlling the numbers allowed into the shop also has its problems. The queue outside the shop grows and grows. People start travelling from abroad to take advantage of the free food. Soon the queue is blocking the whole high street. This needs a management solution. So the managers introduce targets. People must not wait outside the shop for more than, say, four hours. So they double the size of the shop and employ more stackers. They even open another shop to compete with yet more free food. The stackers find there is more work than ever because as the queue time shortens to four hours all those people who couldn't be bothered to wait six hours decide to go shopping for free food. For the queue to grow despite the management's efforts the managers are convinced that the stackers must have been slacking. The managers whose pay depends on keeping the queue short, unusually, take to the shop floor and goad the stackers who are already working as fast as they can. Shortcuts are forced onto the supermarket workers. At the meat counter somebody starts using the knife used for raw meat on the cooked meat. And for a while everything is OK. But then one day there is an outbreak of illness caused by E coli 0157 and a lot of people die. And very curiously everybody is surprised and wonders how this could possible happen.