Market Madness 161

The first post of 2013 comes to you from the cardiac care unit of the QEQM Hospital in Margate. Three days ago I collapsed for the second time in two days; an ambulance was called and a paramedic arrived within 5 minutes, with a full ambulance arriving inside a further five minutes. The NHS at its amazing best. I am well looked after.

This is how the NHS should work; public services provided by the state quickly, efficiently and directly. Yet a couple of weeks previously I had an example of just how the NHS should not operate. I returned from Ghana with a persistent ear infection, resulting in pain, deafness and loss of balance. I went to see the GP who agreed to refer me to a consultant. A few days later, instead of an appointment, I received a letter outlining the NHS “choose and call” programme listing a number of hospitals and phone numbers, and giving me a code to use to book an appointment. This is all in the name of patient choice.

But I really do not want this choice. I want my local hospital – and every local hospital – to have an ENT consultant working to a high standard who can sort out an ear infection. Then I want an appointment to see them quickly. I am not buying a novel or a washing up liquid. The idea that every transaction involving provision of state services should be based on an expensively created and entirely artificial market mechanism is an ideological frippery. Behind that letter lies a mass of administration to record my choice and shuffle invoices and financial transfers between my GP’s practice and whichever hospital I pick. Those invoices and transfers are all entirely internal state administration yet add massively to – multiply – the cost of simply getting a man to look down my ear canal.

There is a parallel here to the private sector distortion by which the middlemen who transfer the money for transactions have contrived ways to complicate that function until they are the major beneficiaries of economic activity.

Thankfully in emergencies this craziness is not yet applied. But I do not rule out one day being stretchered into an ambulance, asked where I want to go and handed a telephone.

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161 thoughts on “Market Madness

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  • Frazer

    Hell, mate…get well soon…as i read where you were i thought it must be your ticker..gave me a jolt i can tell you !! Back next month so i will pop down to see you again…

  • Dreoilin

    What a shock! I hope, whatever it is, it’s not too drastic, Craig, and that you are back at home, safe and well, in no time.

  • David Wilson

    Always good to read your blog, but sad that you have been having problems requiring hospital care. Get better soon, Craig

  • lwtc247

    Sorry that your health right now isn’t top notch.
    By the will of Allah, may you be given a good and speedy recovery.
    I pretty much agree with your expressions of the NHS.

  • mike cobley

    That was a great post, Craig – you hit the nail on the head. Most people dont to have to be bothered with choice when it comes to public services; we should have the right to be secure in the knowledge that they, esp health, are run to the highest standards such that there is no point to exercising a pseudo-market choice. No one has ever asked the public that question, whether they would prefer ubiquitous high standards or some spin-the-bottle choice mechanism.

  • Pan

    Just thoroughly enjoyed reading your Orangemen of Togo book and now halfway through Murder in Samarkand. Fascinating stuff!

    We need you healthy and strong, Mr Murray, so please get well soon!

  • nextus

    What a shocker, Craig! You seemed in tip-top shape at the New Year party, and didn’t show any noticeable after-effects the following day. Perhaps this is a prompt to change long-term health habits?

    Incidentally, on the train back home I started showing signs of flu, and was very ill during the night (I’m still on the mend). Norovirus, I wonder?

  • Rose

    ….yes and all this pointless busyness (and business) of paper-shuffling means a less efficient service and real danger for patients. And it was all justified as I remember in the interests of improving efficiency and cutting bureaucracy. What a (hollow) laugh.
    I wish those whose main interest in life is to make money would just clear off out of health, education etc and flog their shite to each other; don’t they “get” that not everybody wants to be rich, or more powerful and important than the bloke next door?

    Sorry you are ill again Craig and hope that you get well soon.

  • craig Post author


    we were taken ill at the same time then – can you email me your symptoms (through contact button above if you haven’y got my address on you)

  • Mike Gailey

    Not the best start to 2013 for you Craig. Hope you are now on the road to recovery. Strange that I have almost identical ear symptoms, my experience of NHS in Scotland much better too. Two GP appointments and now a referral to ENT at Ninewells in Dundee. They called me two days after my GP passed it on and offered me a choice of dates and times……..

  • Techno

    “I want my local hospital – and every local hospital – to have an ENT consultant working to a high standard who can sort out an ear infection.”
    You expect far too much from the NHS. That is the problem.
    There may not be enough ENT consultants for one in every hospital. Even if there were, there may not be enough work for them to do at a local level so they have periods when they have no work to. But they would still get paid, and consultants are not cheap to employ.
    Being able to choose which hospital is most convenient for a non-urgent consultation is a benefit to many people.

  • karel

    what you desribe happens after intercontinetal flight as alteration of barometric pressure in the cabin and very dry air promote ear infection, usually of bacterial origin. My friend of 62 experienced exactly the same symptoms as you after returning from Bangkok to paris. he was deaf in one ear for about six weeks. Do not wait for a consultant and get some antibiotics, but not those which are ototoxic like gentamicin or tobramycin, It cannot do much harm.

  • Mary

    So sorry Craig. I felt that something was wrong. Hope you have a full recovery and in the meantime get a good rest. It must have been a worrying time for Nadira too.

    The local paper here is now owned by Trinity Mirror, and was previously in the hands of Guardian Media. Look at this puff piece they put in about a local Tory MP. Lord used to work for Saatchi and Saatchi post Eton and university. Enough said. Surrey is unfortunate enough to have Tory MPs like him, Anne Milton one of Lansley’s mob and Jeremy Hunt now i/c of NHS destabilization and its ultimate destruction. Also Gove in the Camberley area and Raab in Epsom.

    The Tory voters in Surrey bear much of the responsibility for putting these Bullingdon poison-Goves in place, unelected by any majority, unmandated, all busily wrecking what’s left of Britain’s social provision.

    See the comments.

    Also this

  • Steve

    hope infection clears up speedily.

    meanwhile, thank you for a brief, witty, but most erudite description of the cancer that admin’ maniacs are inflicting on our most important public services (mostly to pave the way for inexorable ingress of private contractors at the public’s expense)

    shine on

    ps: if you’re cultivating a habit for hospital visits, perhaps better check that your diet is healthy – not missing vital nutrients/vits (find a good holistic nutritionist)

  • Mary


    ‘But I do not rule out one day being stretchered into an ambulance, asked where I want to go and handed a telephone.’

    You missed out a bit there. …. Plus possession of a credit card or proof of medical insurance cover.

  • David Halpin FRCS

    I wish you a very full recovery Craig – of course. Britons and all other world citizens who stand up must be helped back up.

    I started training as a doctor 54 years ago. I have been retired from working as doctor first, and orthopaedic and trauma surgeon second, for these last ten years. I fight at national and local level for the NHS with other like minded doctors – NHS Consultants Association , and currently with a small and good group to keep the 10 beds in the community hospital at Ashburton.

    Your piece Craig hits all the nails on the head – as usual. I was using similar words when Thatcher/Rand Corporation/Centre for Policy Research ** were ramming through the Internal Market in c. 1988. With the doubling of the titles, posts and the desks, administrative costs were at least doubled from c.6% to c.12%. 1.3 billion.

    The storm troopers from Eton have worked on hollowing out the minds. They have almost completed the hollowing out of all that is dear to us within our state. I am preparing an island for them and ‘Choices’ Blair off Tierra del Fuego.

    **CPS web site showing Sir Martin Jacomb of Canary Wharf. Read his words.

  • Justin

    Get well soon Mr Murray. Not a nice start to the year but things can only get better from here! Wishing you a speedy recovery

  • nevermind

    Hope you are getting better soon, Craig, after Nextus thumbs up we thought you were OK, when the opposite was the case.

    Not only has the lack of foresight regards training and reliance on EU agency doctors distorted the need in the past, Techno, you feelings for poor ENT specialists who, according to you, will have to moonlight to make a living, is the argument presented for a privatised market and its presenting a false image, because the vast majority of people, not having made a choice for health services in the past, are now forced into a highly bureaucratic and confusing system.

    Calling it choice takes some chutzpah when the vested interest of 40% of our HoL residents are reliant on private profits from future ventures.

    Rest assured Labour has nothing else to offer, none of them has, party politics is showing its limitations after landing us in this cul de Sac, rather than going for one of the continental models, they sold their souls to a US model which has been shown to fail, especially in large urban conurbations with poor clientèle.

    Parts of LA have no more health care, they are reliant on non stop night health charity sessions, in baseball halls, hundreds at a time, with no separation/hygienic barriers and some infectious patients. Doctors are giving their time for free, or work for a minimum fee, a charitable sticking plaster and far from ideal, but not a healthcare model to modernise what we once had.

    These public sessions are never enough to handle the massive need and some will fall by the wayside, they will not see anybody that night and with distances being what they are, would have wasted their time and energy. Is that what we want here?

  • Hugh Kerr

    Craig you will have to return to Scotland where we have kicked the market out of health.The USA is of course the logical end of these market moves where they spend twice as much on health but with worse outcomes because half of the money goes on marketing administration and profit! Get well soon Craig and happy new year to you Nadira and Cameron. Hugh

  • Anon

    Worth noting perhaps that there is not just a norovirus epidemic but also a rapidly rising number of cases of influenza. The UK doesn’t allow Google Flu Trends to provide estimates for the UK (which I think because it exposes how crap the UK system is in reporting accurate infection rates) so we are stuck with outdated information made even worse by the Christmas/New year break.

    However judging by the infection rates reached elsewhere…

  • Tom Welsh

    Best wishes for a speedy recovery! Please listen carefully to what the doctors tell you, and follow their advice. You are accustomed to expending your energy recklessly, without counting the cost. We’d all like to keep you with us as long as possible, so take care!


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