Lateralism, parallelism, separatism, and other spurious NHS cults

I've just finished re-reading John Le Carré's Karla trilogy, starring the indefatigable George Smiley. A quote within it reminded me of the current British government's abysmally chaotic handling of the NHS. Smiley is contemplating a lifetime spent under the dominant Whitehall doctrine of Machiavellian pragmatism, which is to create an impression of continual change for the good, when in reality Whitehall's only activity is one of enslaving the British population to feed its own whims; Smiley remembers:

"...such spurious cults as lateralism, parallelism, separatism, operational devolution, and now, if he remembered Lacon’s most recent meanderings correctly of integration"

Smiley is an amazing character, and one of my favourites from fiction alongside Rincewind, Aubrey, and of course, Gimli. Yes, Ok, Smiley was Chief of MI6 for a while, heading up the most odious branch of the most odious institution of British life, its government, but Smiley still remains one of my heroes nevertheless; I think his character is summed up best by a brilliant PDF article written by Jeff Scott, in Sean Gabb's Libertarian Alliance magazine:

George Smiley: A Real Hero

To Jeff's thoughts I would add only one further element. In Smiley's last appearance in The Secret Pilgrim, after the fall of the Berlin Wall, he bids adieu to many younger members of MI6 with the following memorable soliloquy:

[Smiley] picked up his balloon glass and peered thoughtfully into it while he swirled the last of his brandy. And I sensed that he was finding it harder to take his leave than he had expected. 'Yes. Well,' he muttered, as if somehow defending himself against his own assertions. 'It's not only our minds we're going to have to reconstruct, either. It's the over-mighty modern State we've built for ourselves as a bastion against something that isn't there any more. We've given up far too many freedoms in order to be free. Now we've got to take them back.' He gave a shy grin, and I knew that he was trying to break his own spell upon us. 'So while you're out there striving loyally for the State, perhaps you'll do me a small favour and lean on its pillars from time to time. It's got a lot too big for its boots of late. It would be nice if you would cut it down to size. Ned, I'm a bore. Time you sent me home.'

Is Smiley, then, a Minarchist? There's a definite hint of Bastiat, a whiff of Locke, and a smattering of Turgot in that last parting shot. Is Smiley even suggesting that western governments need a ferocious 'Enemy Bear' to justify themselves? Have they created another such bear in the Middle East, to replace the Russians? Are they deliberately trying to foment Russia into becoming a bear again, in case their surrepticious Middle Eastern initiative fails? I think we'll need another Le Carré novel to sort that one out, perhaps bringing Peter Guillam out of retirement to do it, played I would think by Ewan McGregor in the Hollywood film version.

But I'm not here to talk about Le Carré, but to take a look at HMG's latest NHS initiative-cum-U-turn, to get non-urgent surgery closer to the General Practice, which I think must fall under Smiley's definition of Lateralism. Let's see if we can predict the next initiative after this one, and then all the subsequent initiatives, until we're back to Lateralism again (probably in the middle of the next Prime Minister's first term in office):

• Lateralism: Let's move surgery out sideways towards the General Practices


• Parallelism: Let's establish a two-tier system of health centres, with overarching control centralized to Health Trusts


• Separatism: Let's create separate sub-bodies within the Health Trusts, dealing with different aspects of modern aspirational health care


• Operational devolution: Let's mandate the Health Trust bodies to operate independently, within an overall framework of market competitive initiatives established and maintained by central control


• Integration: The left hand doesn't know what the right hand is doing, and in following the divisive policies of the last government [insert rival political party], we have created a wasteful and inefficient cascade of replicating services. The only sensible and economically efficient thing to do, to give taxpayer value, will be to establish joined-up government and bring the entire control of the NHS within the control of the minister appointed by the electorate. If a bedpan is dropped in Huddersfield, the minister in Whitehall should know about it.


• Lateralism: Centralism has taken too much power into the hands of Whitehall, because of the failings of the last government [insert rival political party]. We of the [insert own political party] will bring control closer to the people and establish independent health operating units, closer to the General Practices...

Ah, the revolving doors of revolutionary government:

Plus ça change, plus c'est la même chose

A brief message to all those cretinous civil servants who think that they've pulled the wool over our eyes with this latest amazing initiative. I'm sorry boys and girls, but this continuous revolutionary activity within civil service departments to make it look like you're doing something useful may fool a few morons, but I'm afraid you're starting to run out of idiots. The wheels are off, and most of us, including you, know it.

The sooner you get your dead hands off the health system, in this country, the sooner we can get the health services we require. It's as simple as that. Just step aside and get out of our way.

The NHS should be taken out of government control, immediately.