Conspiracy Of Silence

October 23, 2013 5:45 pm

‘We now have the moral authority of the world.’ When Aneurin Bevan made this declaration at the inauguration of the NHS in 1948, he clearly believed that a system of universal healthcare was testament to the evolution of a civilised nation. He must also have believed that such a system was a barometer of a nation’s compassion, aspirations and political will; that government of any political stripe should be benevolent and just.  And he was right to believe that.

But a worthy concept does not preclude itself from reservations about the way in which it is implemented. As miraculous as the NHS is, and it truly is a miracle, it cannot be exempt from continuous commentary about its infrastructure and delivery. Indeed, such discourse is necessary for a public institution to be accountable and to improve. There is no doubt whatsoever that the NHS has provided careers to vast numbers of professionals, and that public money has helped in part to fund their education and training. A debt of honour and a sense of loyalty are expected and commendable. But blind loyalty is of service to no one and deceives everyone.

Perpetually lurking in the background is an idea that the NHS should be above reproach from those who work within it, and any defiance would undermine the confidence of its patients and the morale of its employees. It is understandable, therefore, that the NHS has been called the third rail of politics; one dare not touch it for fear of being burned alive. Or perhaps it is because the third rail is where the all power is.

The universally acknowledged truth that such an institution should impose a tacit edict prohibiting anyone from dissent seems tantamount to tyranny. But this conspiracy of silence defies the simple logic that the very people involved, served by and delivering the institution are entirely qualified to question it. In fact, it can easily be argued that since they are also funding the NHS, it is their obligation to do so. To merely immerse in apathy and stay silent while the NHS behemoth wheezes and splutters onward is a form of supervised neglect.

Of course there are countless channels and safeguards within the bureaucratic mountains of the system to allow for accountability and reproach. But these are often patient-centred and offer little scope for the clinicians to openly register their disquiet. Many professionals within the NHS do articulate their issues with great zeal, but sometimes even the very act of writing about these grievances invites castigation from many colleagues. Someone has to make the case for their freedom to do so.

I’m old enough to remember the Cold War and I’m pretty certain that we won. We championed and espoused the value of freedom, and berated anyone who muzzled the expression of free people anywhere. Like the NHS, this liberty is free at the point of delivery, since it was bought for us by the ultimate sacrifice of millions and is enshrined in law. To speak out or protest against anything is not only the surest demonstration of this liberty, but it is our birth right as citizens of this great nation.

Why, then, do so many professionals working within the NHS feel they must surrender this liberty to both an ambiguous allegiance to it, and also to a fear of reprimand? Would their criticisms affect the credibility of the institution? Would it jeopardise their contracts? Does self-preservation within an institution outweigh the duty one has to try to improve it?

Sadly, the answer to all of these questions is invariably yes. Consistent with this, the tyranny with manners that some call political correctness has become the weakness of our time, making us hostage to the potential sensitivities of a few, instead of reciting the views of the many. The minority of people asserting this intellectual elitism would have society travel down a road where the inevitable destination would have no forms of expressions whatsoever; no music, no art and no theatre, for fear of upsetting someone. The majority of us, however, understand that this is the miniscule price to pay for speaking freely.

There are now more streams of media for individuals to use at their leisure and will than ever before in our history, and one might say that this exemplifies the unbridled freedom that we all enjoy. But many opinions are expressed anonymously through these media for precisely the reasons already outlined. Far fewer brave souls are willing to attach their name and stake their claim to a genuine grievance or criticism, resigned instead to diplomatically conform to an existing standard.

And so, our public institutions will never see the rising sun of excellence if those working within them are not bold enough to voice their concerns. Discussions in the canteen, waiting rooms or practices will amount to very little more than frustration for their participants. Everyone has an investment in the NHS, and thus everyone has an inalienable right to criticise it and remain free, not from rebuke, but from reprisal.

Come forth hither and speak your mind.

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