14 March 2019
I am in the process of reading a very interesting book by David Seedhouse, ‘Fortress NHS: A philosophical review of the National Health Service’. Written in 1994 he thinks the ‘…present proprietors of the NHS show no qualms about implementing tough practical measures to prohibit free speech (p.28), so again nothing has changed. Paper six entitled ‘Fortress NHS’ provides a description of the structure of the Fortress (see diagram below). There are the outer walls which are part of its ‘shield’. ‘The key components of the outer structure of the fortress are mythology (the continuing faith of the British people – most of them outside but some within – that the NHS is fully and coherently principled); the results of political compromise (both at the outset and throughout the development of the health service; hierarchy, internal regulations and discipline (used – increasingly these days with the advent of the manager – to minimise both protest and innovation); and professional and personal self-interest (disciplines and individuals benefit from working for the NHS and so have developed a range of methods to ensure that they continue to do so’ (p.99). There are ‘perimeter strongholds’. These are peopled by those ‘…external to the NHS who have a strong financial interest’ in the NHS such as the drug companies and other manufacturers. ‘The drug industry in particular is a powerful ally, indeed some would say it is part of the Fortress’ (pp.99-100). Other security systems and defences are in place inside the walls, ‘…behind the existing wall of mythology’ (p.101). ‘Fortress NHS has found it necessary to employ tactics which some might choose to describe as brainwashing’. There are four types of defences. 1. Use of special meanings ‘…words which have well known meanings in everyday life are given new and different meanings within the Fortress’ (p.101); a contortion of meaning. E.g. ‘Inside the Fortress quality is cheap’ (p.102) 2. Esoteric use of language Excessive use of technical language 3. Creation of an artificial framework This defence works by ensuring that the ‘…special meanings and use of language seem normal and not contrived’ with the result of a ‘numbing effect on the intellect’ (p.101) 4. Rhetoric is used incessantly Everyone begins to talk in the same way. One of my research focus groups discussed how acronyms prevented thought: M Yes, they come across as feeling threatened, but also they are trying to control the definition of um, what can be talked about, aren’t they? They are sort of, and they are hoping that if nothing gets talked about, nothing can be thought about G And then nothing needs to be done M And then nothing needs to be done, so uh, Orwell talks about in 1984, he talks about how acronyms are used to stop people thinking. The NHS is full of acronyms for example. So the relevance of what I am saying is, so if you talk constantly in terms about GB4’s and… M All these sorts of things people have, this language in talking that closes down, makes it impossible to think A People don’t know what acronyms mean half the time G Yeh, that’s right M They don’t know how to think about. It closes down thinking, so in this way I think, it’s a kind of, also probably not a conscious strategy, but it is a way of trying to close down conversation, thinking, people trying to do, you know, people trying to get engaged with the issues A This is confidential OK. But the e-mail we had recently from our manager contained two or three acronyms and I didn’t understand two of those… A I’ve worked here for twelve years, got no idea what those two acronyms mean. That one I know, those two, have never heard of before. As a consequence I had no, I really didn’t understand G There is a lot of those... A Why I was supposed to know? S It’s like the NHS has always had that hasn’t it?... G Yes, yes… M What it boils down to I think is who defines what can be talked about, what the truth is, how something can be understood. Who’s got the power to do that? And they are using their power in an absolutely obnoxious way
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