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Sean Roche: Influencing public perceptions of the NHS—the politics of fear and the manufacture of consent

4 Jul, 13 | by BMJ

sean_rocheAttending to the health secretary’s recent pronouncements and politicking around the state of the NHS, I find myself reflecting on rather striking parallels with the propagandising that preceded the 2003 invasion of Iraq.

Most obvious is the utilization of fear and anxiety to influence public opinion and create the requisite conditions for state actions that would likely be opposed under other circumstances. In “The Administration of Fear” the philosopher Paul Virilio observes that in the contemporary world, states often seek legitimation through the promise of “health” and “security.” Certainly “security” was the prevailing motif in the build up to Iraq—recall the ominous (ultimately false) claims that weapons of mass destruction could rain down on us with only 45 minutes warning. Likewise Hunt, in a mode of unabashed fear-mongering, warns the public that hospitals no longer offer security from suffering; on the contrary “every other day we leave a foreign object in someone’s body, every week we operate on the wrong part of someone’s body, and every fortnight we insert the wrong implant. This is the silent scandal of our NHS.” It seems that hospitals now join the ranks of terrorists, pandemic flu, and other nefarious forces against which the state provides its benevolent protection. I’m guessing Jeremy Hunt understands that a pervasive state of anxiety allows the previously unthinkable to become resolutely possible. This is why such grotesque attacks on civil liberties and the privacy of citizens, surely unthinkable prior to 9/11, have met with a depressing degree of passivity.

Leading up to Iraq it was not only a matter of advertising the threat itself, but beyond this the authorized inspectorate—the UN weapons inspectors—had to be discredited as unreliable. By analogy, we are informed that not only are hospitals waiting to inflict vile malpractice on the unwary, but to make matters worse, the Care Quality Commission cannot be relied on as a safeguard. Who could blame the public for being afraid? And who could blame them for acquiescing with whatever proposals are put forward to restore a sense of “security?” Such methods for manipulating the public mind in the service of state and corporate agendas have been described by Noam Chomsky as the “manufacture of consent.”

The crucial question is what the public might find themselves consenting to. I have my suspicions that another large-scale invasion is being prepared. As I write, both here and across the Atlantic, battalions of private health providers and health insurance companies are poised for the big push, for the ultimate regime change from public to private health provision within the NHS. But externally enforced regime change rarely benefits the population. Just as the black gold from Iraqi soil flows into Western oil barrels, so shall the public wealth in the NHS be siphoned into private pockets. Surely this is the silent scandal of our NHS.

Declaration of interest: I have recently been appointed as a second opinion appointed doctor for the Care Quality Commission. 

Sean Roche is a consultant psychiatrist in north London, and a visiting research fellow in philosophy at King’s College London. After completing his philosophy PhD in 2011 he has maintained a research interest in philosophical and political issues that are relevant to both psychiatry and medicine.

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