I return to the excellent book by Claire Hilton “Improving Psychiatric Care for Older People: Barbara Robb’s Campaign 1965–1975”. She writes that “Under the nom de plume ‘Pertinax’, Hugh Clegg, professor of industrial relations at Warwick University...wrote in the BMJ:
More and more are responsible voices beginning to challenge many of the assumptions on which [the NHS] is based. Many must be rubbing their eyes and asking themselves why such a large carbuncle on the body politic has only just began to look so angry. The short answer is that there has been a conspiracy of silence, a conspiracy fostered by those in control and those afraid to speak (Pertinax 1967).” The original article by Pertinax (1967) goes on to say that people are not allowed to make even “…fairly mild criticisms of the N.H.S.” and “In those years of the locust anyone criticising the N.H.S. was accused of denigrating it, and the accuser did not hesitate thereupon to denigrate the so-called denigrator and all that he stood for”. He then writes something which I consider to be extremely important and perhaps quite prophetic. “I am recalling these things because unless we learn the obvious lessons we shall get deeper and deeper in the mire of self-deception. This is what has harmed and will continue to harm the N.H.S. I have no time for those who wish to destroy it or injure it irreparably; and there are such. I think that the N.H.S. could even yet become something that the rest of the world would wish to imitate. But I am sure that this will not happen unless the conspiracy of silence is defeated and until more people have the courage and come out into the open and tear away the pretences that are now part and parcel of British public life.” He considered the public and the profession had “…become bemused by propaganda and wishful thinking”. Over fifty years later one of my research participants thought that “The NHS is an ‘unimpeachable institution’”. “…unimpeachable means that the general public, social attitude surveys always find the NHS is ‘respected’, ‘beloved’ and all that”. “…unimpeachable is very dangerous. Bit like the royal family you know, nobody criticises them, but nobody dare, you know, cos they’re unimpeachable” “…the, politicians have said to me, look [name] you cannot, cannot criticise the NHS”. I believe that Pertinax was right. We are mired in self-deception and a pretence that things are what they are not. People have to be able to criticise and challenge without fear of retribution. If there is a resistance to knowledge and an inability to accept criticism the NHS cannot learn and improve.
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