Sunday, 12 February 2012

NHS reforms-Evolution or revolution?

The UK government says its National Health Service 'reforms' are 'Evolutionary, not Revolutionary'. This throws up some strange ideas. This might seem a trivial and opportunistic comment, but hear me out.

 Currently, Britain has a state run near monopoly healthcare provider, the National Health Service which in theory is ‘Universal (treats everyone) Comprehensive (treats everything) and Free at the point of use.’ Presently the NHS is going through another of its periodic re-organisations. The politicians are addicted to re-organisations; they call them ‘reforms’. If you say ‘managerial shake-up/reorganisation’ people groan and say ‘Oh no, not again!’ whereas if you say ‘reform’ it sounds noble and grand. And thereby hangs a tale. Loading misleading meanings (positive or negative) on to words is an effective strategy used by partisan politicians, other confidence tricksters and writers of fiction.

It would take thousands of words to describe the arguments for and against these contentious reforms even in outline and that is not the focus of this blog, I’ll come to the connection in a few moments. Essentially, they are top-down, government driven, introduce competition between healthcare providers, are said to be about ‘choice’, ‘progress’ ‘excellence’ and various other happy words, and are to be imposed on a reluctant healthcare work force by a government ‘because they can’. The 5 most important criticisms of the reforms are that (A) they will cost a lot of money to implement, (B) hardly anyone understands them, (C) they are untested, (D) have created uncertainty in which experienced staff are leaving and forward planning is blighted, and (E) with a very few exceptions, the entire healthcare profession is opposed to them for the above reasons. Andrew Lansley, the Conservative politician who masterminded the reforms brushes the criticism of doctors, nurses, midwifes and patient representatives away, accusing the professionals of protecting their vested interests or opposing reform because the government is worsening their pension arrangements.

On today’s news, the Prime Minister David Cameron came to his Health secretary’s defence, saying the NHS reforms, and here I come to my main point, were ‘Evolutionary, not Revolutionary’ 

The reforms are evolutionary? Well that is interesting. Because I thought that Andrew Lansley had actually thought about the reforms, that they had a goal, that they were, dare I say, intelligently designed.

Getting away from the narrower point about healthcare provision, important though this is, there are a couple of important points here about language, which is of course the medium we use to communicate meaning. I know the English language is a funny old bird, that there are nuances and changes over time, but if the meaning of a word is to be changed out of recognition, we should be alerted to this. We need straight language that means what it says. Calling these reforms  ‘Evolutionary, not Revolutionary’ is wildly inaccurate. The changes are clearly revolutionary, in that they are a sudden change, imposed by design, from the present system to a very different way of doing things. In Darwinian evolution, things happen very slowly over a great deal of time, small (too small to observe, that’s why they have to be imagined). In Darwinian evolution, many variations are thrown up by random mutations, the ones which are an improvement (if any) are conserved, the others (the vast majority) are ‘ruthlessly exterminated by natural selection’ (Darwin’s phrase). 

Hold on a minute. Do I want my country’s healthcare system, on which my loved ones and I may depend and for which I am heavily taxed, to be subject to this kind of process? I’d much prefer an intelligent design model. 

So there are 2 interesting points about language and meaning which arise from this. One is that the terms evolution and design are yet again being mixed up in a chaotic manner which makes reasonable discussion about either process impossible. I have said before that this makes it more difficult to hold the evolutionists’ feet to the fire about the scientific failures of their ‘microbes to man by natural selection on random mutations’ hypothesis.

A second point which I have not made so often if at all, is that evolutionary thinking seems to have crept into general thinking as a way of understanding creative processes. In short, if our politicians, opinion formers and leaders actually BELIEVE that the most potent creative force of all, the one that made life including Man, consists of the production of large numbers of entities more or less at random and eliminating the least fit by destructive competition until you are left with the best, then this is the process we should use in our statecraft, industry, public service etc. Lansley’s NHS reforms are predicated on quality and value arising from competition in a healthcare market.

In other words, when men believe that the processes imagined by Darwin are the deepest underlying reality concerning creative processes, and that there is an ‘onwards and upwards’ progress, they apply this kind of thinking to policy. Why wouldn’t they?  After all, as a Christian I take God’s word into account and pray before I design a project in my life. If they believe in ‘progress’ through natural selection acting on chaos, perhaps they believe that creating chaos is the key to progress. Far fetched? I have heard this many times.

We act on what we believe. If our leaders believe the Darwin mythos, they will act on it as trhey plan our lives away. This explains a lot.

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