Fruitless attempts to create equality in a complex world can have disastrous consequences

The instant I heard how the NHS was treating Colette Mills and Debbie Hirst, the image came to me. Here we go again, I thought.... They both have cancer. They wish to benefit from a relatively new drug called Avastin, but the drug has not been approved for use by the NHS. It does do some good, but it is not regarded as cost-effective. So the two women decided that they would buy the drug themselves. Fair enough? Apparently not. The two women have been told that if they pay for the drugs, NHS treatment will be denied to them. They have to pay for all their care privately, an impossibly large sum, or receive it all through the NHS. Alan Johnson, the Health Secretary, was firm on the subject. They cannot, he argued, "be treated on the NHS and then allowed, as part of the same episode and the same treatment, to pay money for more drugs".

But the reason he gave was not a medical one - that drugs needed to be administered together by the same doctor on NHS time. Or a practical one - that it would be a bureaucratic nighmare to have some drugs for sale and some not. It wasn't a legal one either: it isn't at all clear that the law prevents this mixture of the NHS and private treatment Instead he said this of the request by these gravely ill women: "That way lies the end of the founding principles of the NHS."

Now Mr Johnson is a compassionate man and an intelligent one, too. He's not, in my experience, generally dogmatic. So what on earth possesses him to deny cancer treatment to these terribly sick patients? Where could such an idea come from? Sootynomics.

Last year was the 50th anniversary of Tony Crosland's book, The Future of Socialism. While re-reading what was, when it was published, one of the most important books of social democratic thinking, I was struck by how dated it had become. Crosland spent half the book in earnest dispute with people advancing ideas that are, to the modern eye, completely ridiculous. He patiently explains, for instance, over an entire chapter, why guild socialism - a barely comprehensible scheme in which trade groups control industry - wouldn't be a bright idea.

What has changed over the past 50 years is this: we now appreciate, or at least have some inkling, how big and how complicated the world is. When there are staff employed in the occupational therapy unit of the IT centre of the people who make the dye that colours sliced bread packaging, how exactly does guild socialism work? The idea of a fully planned economy, painstakingly criticised by Crosland, now needs little effort to refute. It has simply fallen away.

Yet there remains an extraordinary amount of public policy confidently advanced without any idea of the massive contrast between the size and complexity of the world and the puny measure being proposed, without any understanding that the world rages on like the sea - unstoppable, uncontrollable. The absurd idea, for instance, that you can tackle obesity by banning food advertisements on children's television (an apt example of Sootynomics, come to think of it) or stop climate change by using fewer carrier bags at the supermarket. I remember one of my colleagues calling for a boycott of Tesco because it was killing the high street. The last time I looked, Tesco was still trading.

Alan Johnson's NHS ruling is a perfect example of the same syndrome. What is the fundamental principle whose end he fears? Not that care should be free at the point of use, since he already believes that to use Avastin, you must pay for it. No, the principle to which he clings is that all patients should receive the same care. There should be equality. Do you see what I mean when I say it would be comic if it wasn't a tragedy? Mr Johnson looks at the world with its vast disparities in wealth, with its teeming masses and its warzones and its starving slums and its clipped suburbs and thinks he can make the world more equal by preventing a couple of women buying Avastin.

Actually, never mind the starving slums and the warzones, there isn't even equality inside the NHS. There are cancer drugs you can have prescribed in Scotland that you can't have prescribed in England. You can pay for some dental services while receiving others on the NHS. You can receive two different but related treatments and pay for one of them as long as you don't have the treatments together in one place as one episode.

Alan Johnson is trying to hold a line that cannot be held. As more expensive drugs become available and are deemed "not cost-effective" the Mills and Hirsts will multiply. The offence against their rights will be seen increasingly as unacceptable and the pursuit of an elusive equality ever more obviously futile. You may as well stop planing down the tree now, Mr Johnson.

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A good comment on the above from a "Times" reader:

This long-standing NHS policy is symbolic of the vicious logic of Britain's socialism. It is the politics of Iago: "If Cassio remain/ He hath a daily beauty in his life/ Which makes me ugly." Like the nasty kid in the playground, we will attack anyone who is better than us.

It is also tribal. The NHS treatment is "us". You are either with us, or outcast. It reminds me of the provincial museum official who denied entry to a public school group. "They're not us. They can't use our facilities." Thankfully that nasty piece of tribal nonsense was over-ruled by Tony Blair. In this more tragic case and many like it, the vicious 'if I can't have it, neither can you' policy of tribal doctrinaire socialist equality will continue.





British medical education bungle good for Australia

A BLUNDER in a jobs recruitment program in the UK will result in relief 19,000km away with hundreds of doctors set to migrate to Australia to help fill staff shortages in our ailing public hospitals system. More than 5000 British medics have found themselves unemployed after failing to get a training post at hospitals in the UK. Two years ago, with critical shortfalls in the number of doctors, the British government lifted the number of places available at training schools and centralised the recruitment system. But it failed to take into account how many places there were available in hospitals to provide internships or hands-on training for the medicos to complete their training.

The British Medical Association said yesterday the only winner would be Australia, with hundreds of young doctors applying to complete their training and fill critical staff shortages. Most of the doctors have applied to work in NSW and Queensland hospitals but a BMA spokesman said hospitals across all states could expect British applicants in the next few months when the true number of training posts available became clear. "It's just a ridiculous situation," a spokesman said. "They increased the medical school places but gave us a situation now where there are only between 8000 and 9000 places (in the UK) but about three times as many applicants. "Not being able to complete their training means they have to put their careers on hold, take a non-training job or practice abroad. The loss to the UK is a gain for countries like Australia and we know a number who are planning to head there."

Dr Robert Thomas spent a year at a NSW Central Coast hospital but was one of the few to find a place in the UK to complete his training. "I was lucky but a lot of my friends are still planning to travel to Australia to work in hospital accident and emergency wards," he said. "I think you will find most will go there for training but will stay there for good. The life is so much better."

An official inquiry into how thousands of doctors missed out on UK places last week concluded the government and Department of Health should be stripped of responsibility for the recruitment system.

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