Recent NHS scandals place doubt on its mandate

Mathieu Vaillancourt,


The Mid Staffordshire NHS Trust scandal has become a political time bomb, so much so that David Cameron has said that the NHS chef executive, Sir David Nicholson, should seriously reconsider his position as Chief Executive of the National Health Service.

Of course, Sir Nicholson should resign for being at the helm of the hospital which saw 1200 people die on his watch.  However, the biggest challenge goes way beyond this scandal; it makes you think about the whole mandate of the NHS.


Is the NHS really about patient care (which is seeing the patient as a customer to serve) or about having a pyramid of vested interests which is impossible to reform in the long run? Except in extreme cases such as the Mid Staffordshire NHS Scandal, what is exactly the incentive for the NHS (considering his legal purpose) to offer a better care to a given patient?

The other fundamental question is of funds related to a system like the NHS. Everybody always wants more funds, but how much of it goes really into patient care and not into another technocratic layer?

For these reasons, I think that a system like the NHS will sooner or later collide in its own weight. Until then the system will be cutting into the things which are less damaging in term of corporatist interests. For instance, an easy way to reduce cost in a state-based healthcare system is to ration a given product. It will be still ”universal” but it will be rarer and you will wait for it longer rather than in a market based system. One Canadian Supreme Court case in 2005 (Chaoulli v. Quebec (Attorney General)) did conclude that rationing healthcare in a state-based system was leading to ”inhumane” waiting lists and this was going against the Canadian Health Act.

Indeed, to buy peace, it’s easier to give more money or better benefits to a given group of people working in the NHS, than to give these funds to patient care as the patient is only considered a tool in the whole process.

This is why a system like the NHS goes against the same principle of fairness, every citizen pay taxes for it, but you are a ”special interest” like the handful of others on the list vying for the same funds. Only difference is that the patient ”lobby” is not as strong or powerful as the others. This could be a good explanation why any politician is not too keen to shake things up in the NHS hierarchy.


(1) Note that the NHS Chief Executive have a bigger allowance in lodging than any elected official in the UK.


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