Should medical patients be customers or burdens?
I know first-hand how appalling NHS care of elderly patients can be. I've been a critic of the NHS for at least the last 35 years, but even so, the inhumanity of how it treated my mother in her last weeks took my breath away. And I'm usually pretty good at taking public servants to task, but even so, the whole experience left me sobbing with frustration. Yet I knew then, as we all know now, that such treatment was not the exception. It was, as I could see from life on my mother's ward and as we now all see from the stories that are peppering the press, the norm.
It all happened at a time when the NHS had received a huge cash boost from Gordon Brown and many people were arguing that it provided excellent value for money in terms of medical outcomes, such as longevity. Current data on the UK's awful record on cancer outcomes is just one indicator that this is not so. But even if the NHS's technical outcomes were the best in the world (and it's far short of that), what is most wrong with it is that it treats people inhumanely.
In a recent book on The Morality of Capitalism, US think-tanker Tom Palmer talks of his treatment for a serious condition in both public and private hospitals. In the private hospital, he was seen quickly by the right people, treated as a human being, everyone took an interest in him, and they respected his wishes. In the public hospital, he waited, was bossed around despite being in pain, had no human engagement with his doctor, and was generally treated as a piece of meat.
I don't think for a minute that working for a private or a public institution fundamentally changes people's basic humanity. But the incentives in a private system nevertheless encourage them to show more of their human side. That is because they see the clients they have to deal with as valued customers: their job, their income, would not exist if those customers were not satisfied. And they know from their own experience that the way a service is delivered – the cheeriness, the human engagement, the concern – are as much a part of a customer's satisfaction as getting the service itself. By contrast, the incentive structure in too many public services induces staff to regard customers as a necessary inconvenience. Shouldn't we prefer a system that positively encourages and brings out people's humanity, rather than one that discourages and so obviously represses it?