Trust in reform to kill off poor NHS services

Everyone knows the shorthand version of Darwinism - 'the survival of the fittest'.

The GP Record, by Fran Orford
The GP Record, by Fran Orford

But there's another way of describing it: 'The demise of the weakest.' It's the obverse of the evolutionary coin, and one we must recognise.

My thoughts turned to this while watching an interview with a trades' union representative (who looked to be nearly in tears) protesting that the Health Bill proposals could result in the shutting of weaker units or even hospitals.

Good, I thought. It's time they went. That's what it's all about. We don't want inefficient units to be supported inappropriately. Society doesn't benefit if poor-quality doctors, nurses or managers continue to practise - it's not good for patients.

This is where evolution and economics come together. In The Undercover Economist Tim Harford demonstrates that when industries indulge in protectionism it kicks back at them: put bluntly, society as a whole becomes the poorer whenever it attempts artificially to protect markets or jobs. Standards fall, overall costs rise and red tape increases - either singly or all together.

The conclusion is: don't cocoon inefficiency. What is sad for the individuals concerned is, in the wider context, good for society as a whole.

Yet there is a paradox here. Our very British concern for the disadvantaged leads us to support the weakest in society: the poor, the sick and the needy. We certainly shouldn't employ a strict evolutionary approach with individuals' health, because this way lie the evils of eugenics.

But morally there is a world of difference between applying Darwinism to individuals and applying it to inanimate systems. Indeed, we will look after the disadvantaged in society most effectively by being truly evolutionary about our healthcare systems. If a clinician, clinic or hospital is failing because it is incompetent, out of date or inefficient, or it no longer has a community to serve, then let it go under. By all means indulge in remedial treatment if the resources needed are commensurate, but the basket cases should go to the wall. It's good Darwinism.

Evolution unequivocally means the demise of the weakest. Let's use it, unrestrained, and without shedding any tears, to cleanse the NHS of its encrusted systemic debris.

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