Blue and Yellowy blue

So we are now a few months into having a Coalition Government. Whenever I hear that phrase it somehow sounds wrong. I think it’s because I’m so used to hearing about Coalition troops in Iraq and Afghanistan. I imagine a squad of twenty aggressive fuckers wearing blue, excited and ready to take on the enemy, and three or four soldiers wearing yellow hanging out at the back and quietly wondering if  there’s a more civilian-friendly way of attacking the stronghold. But in the end they are flattered by the attention of the others into grabbing the grenades and leading the assault.

I read yesterday that the welfare minister said that the Government wanted to come up with "a new definition of homelessness". Presumably to save money only people actually sleeping in cardboard boxes will now be considered worthy of help. Any plastic covering will make you ineligible for benefits.

What next? Education ministers coming up with a new definition of clever? To include anyone not actually stupid enough to cause themselves harm without constant supervision?

Health ministers coming up with a new definition of illness? To insist that the NHS doesn’t need to treat you unless you are actually going to die in the next 3 hours?

They may not have done that, but the Coalition has done something pretty damaging.  They’ve abolished NICE, the National Institute of Clinical Excellence. I always thought that acronym was part of its problem. It sounds too suspicious. At primary school we were all told not to describe something as simply “nice”. It sounds weak and pathetic. Maybe the organisation would have been more secure if it had been called the Society for Pharmaceutical Organisation and the Rationalising of Therapies, or SPORT. No Government would ever dare abolish SPORT!

But NICE was always in trouble, because it was hated by the Daily Mail and the Daily Express, who seem to base much of their coverage on the basis that everything causes cancer and everyone is going to get it. NICE is there to decide which treatments are affordable for the limited resources of the NHS. To the Mail and Express this smacks of communism. The idea that a drug that costs millions and might only extend life by a few weeks is perhaps less affordable than one that can help many people have a better quality of life, is seen as some sort of fascistic rationing, and must be stopped.

The Government has acceded to these demands, and wants to introduce a free market system for drug sales in the NHS. If a GP decides that a drug is necessary, he can prescribe it, regardless of the cost, as long as it stays within the overall budget of the GP’s practice. It's the wonderful free market in action again!

In theory this might work, but only in a world without advertising, marketing, over-worked doctors and above all the Daily fucking Mail. Because in reality GPs will be pressurised into providing drugs that they can’t afford as a result of slick marketing from the drug companies and in the fear of being attacked by the tabloids.

This will lead to scenarios where you might go to your GP with a cut on your hand only to be told:

“Sorry. Ideally I’d give you some antibiotics for that, but we’ve got no budget left this month. I spent it all on a new drug to keep Mrs Smith alive for another 2 months. Yes, she is the Mrs Smith whose face was splashed all over the papers recently, demanding that I treat her, despite her being 98 years old. Yes, she is also the Mrs Smith who said I was “worse than Hitler” for suggesting that our inner city practice might have some priorities other than her case. But I can assure you it has nothing to do with our budgetary situation. Why not come back next month and I’ll see what I can do, assuming you have any of your hand left by then…”

We need things like NICE. In the same way we need the Health and Safety Executive, the Office for Fair Trading and many other organisations. Yes, in a perfect world a free market would provide many of the services we need for a reasonable price. But we don’t live in a perfect world. We live in a world where Simon Cowell exists and yet hover-cars don’t. A world where a billion people are in poverty and yet Piers Morgan has a job. A world where bankers can make up money and then get given billions of pounds of real money to replace it when they realise they can’t spend their made up money anymore.

Essentially, our world is full of dicks, and a free market will only allow the dicks to prosper. If we want the occasional nice (sorry!) person to do well, without having to become a dick, we need to have some regulation and organisations to do it.

Or we could just redefine fairness as: “whoever has the money gets more.” And leave it at that.