New Labour, new Stalinism

Sir,

No-one knew more about Stalinism that Alexander Solzhenitsyn. In the
foreword to his best known work he wrote:

" If it were possible for any nation to fathom another's bitter
experience through a book, how much easier would it be to avoid calamaties
and mistakes. But there is always the fallacious belief 'It would not be
the same here, such things are impossible' Alas the evil of the twentieth
century is possible everywhere".

I don't think anyone is suggesting the NHS is a totalitarian state
but that doesn't mean all is well.

Many senior staff, both managers and clinicians, are well aware that
if they speak their minds then, at best,they may be denied access to
funding. At worst they may be encouraged to move on.

This goes on against the background of a sustained press campaign in
which the same half dozen news stories are endlessly recycled to create an
atmosphere of crisis in which the public don't know who to trust.

Whether this is a case of doctor's getting their just deserts is,
frankly, beside the point. The effect of this campaign is to distort and
corrupt what should be an informed debate about the values which inform
the provision of healthcare (1).

The NHS belongs to all of us. We all share ownership of its problems
and we are all responsible for their resolution. Creating divisions
between those who provide the service and those who use it may serve short
term tactical ends. However, if the history of the twentieth century
teaches us anything, it is that the politics of division are ultimately
bankrupt.

John Hopkins

(1) Smith R Stumbling into rationing BMJ 1999 319; 936

whereas i agree entirely with the sentiments in your article at every
level i encounter within the nhs i cannot agree with your title. There is
an enormous difference between the odious overt murderous regime of
stalinist russia and today's nhs politics. Your tabloid title merely adds
fuel to the flames of spin currently so much in vogue in politics and
thereby continues the current language game. If you are to argue this
corner appropriately you must deliveer your message in more realistic
rational appropriate wording

Sir,

Doubtless the BMJ Editor can look after himself, but two of today's
rapid responses seem illustrate the paradox of journalistic
responsibility.

Steven Senn ("mote and beam") derides the BMJ's account of what it
describes as Stalinism in the NHS, while Robert Kirby ( "BMJ Editor to
blame for insult" )calls on Smith to resign for publishing an article
critical of NHS Consultants.

I happen to think the article by Light was ill informed and misguided
but it represents a longstanding argument about the NHS Consultant
contract. It is surely better to air these views and answer them with
reference to the facts, than take their publication as a personal affront.

As far as Stalinism is concerned, that was above all about the
suppression of dissent. Recently the Health Service Financial Management
Association predicted a substantial NHS overspend. The facts were not in
doubts but the HFMA was heavily criticised for embarrassing the Department
of Health.

No less a figure than Ken Jarrold CBE, a former Head of NHS Human
Resources, went on the record in the NHS Confederation newsletter and the
Health Service Journal to condemn the political spinning of facts.

Dr John Hopkins

a timely summary of the new politik, thank you for clarifying in
print what many of us feel at the front line i.e. chronic lack of support
from government..........how many hospital beds could you fit in a dome
???