Ep. 40: A “Culture of Death,” Rupert Darwall on Britain’s National Health Service

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Episode Description

“Essentially, the clinicians [at Gosport Hospital] were running an involuntary euthanasia board.” ~ Rupert Darwall

Britain’s esteemed National Health Service has been hit with another scandal: 650 patients unlawfully killed, according to an independent report by The Gosport Independent Panel. Rupert Darwall, multipublished author and contributor to the Wall Street Journal, goes in-depth into what went wrong. We discuss his haunting piece for the WSJ, “Reform the NHS Before It Kills Again.”

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Show Notes (abridged script)

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Rupert’s Background


Rupert is a graduate of Cambridge University, a co-founder of one of London’s leading think-tanks, a multi-published author, and a contributor to the Financial Times, Wall Street Journal, and other major news sources.


Some of Rupert’s books include, Green Tyranny: Exposing the Totalitarian Roots of the Climate Industrial Complex, The Age of Global Warming: A Historyand A Better Way to Help the Low Paid: US Lessons for the UK Tax Credit System


Today we discuss Rupert’s opinion piece for the Wall Street Journal entitled, “Reform the NHS Before It Kills Again.” His article heavily references a report by the Gosport Independent Panel, who found “criminal” occurrences throughout Gosport War Memorial Hospital.

“They were basically killing off, or as the report says, ‘shortening the lives’ of these patients.” ~ Rupert Darwall  

Rupert has written many other articles for the Wall Street Journal. In 2013, he wrote one entitled, “Why the NHS Keeps Failing Britain.” Rupert says, this article was on another independent report on the failings of the Mid-Staffs Hospital.

How the National Health Service Works

Government as the Funder and Provider of HealthCare

“What we have in the UK is the government as both the provider and funder of healthcare.” ~ Rupert Darwall

Most hospitals in the United Kingdom are owned by the government, Rupert tells us. The primary care physicians have contracts with the NHS. Rupert ultimately describes the NHS as a “fully, deeply nationalized system of healthcare.”

Who has access to care?

“The big selling point of the NHS is it’s open to everyone.” ~ Rupert Darwall

England, Rupert describes, has a slightly better system than other parts of the UK. Reforms in the 1990s and by the Blair Government in the early 2000s attempted to open up healthcare and create “choice and competition.” The choice, at best, comes down to two hospitals.

Can they choose their doctors?

“The choice is very limited. So, the poor people of Mid-Staffs, for example, didn’t have a choice. They went to Mid-Staffs and they knew it was a terrible hospital. They felt they had no choice but to go there.” ~ Rupert Darwall

While there may be more choice in metropolitan areas like London, other regions in Britain have fewer options. The patients who received “terrible care” from the Mid-Staffs hospital a few years ago were not able to leave.

“It’s the lack of choice, lack of competition, that is the big problem when you have a monopoly provider.” ~ Rupert Darwall

Rupert attributes this lack of choice to government provided healthcare. When government is both the regulator and provider of healthcare there is an immediate conflict of interest.

“There’s a similar problem with the Veterans Affairs in the United States.” ~ Rupert Darwall

Are members of the British Government on the same system?

“It’s like this great virtue signal, ‘I got treated on the NHS. The NHS is wonderful.’ But if you’re senior politician, obviously you get treated better. You’re not going to wait in line.” ~ Rupert Darwall

Positive Aspects of the NHS

One aspect that used to be a positive, is government, as a funder of healthcare, can limit healthcare expenditures. Rupert, however, believes the markets and the people should determine how much is spent on healthcare––not the government.

“Reform the NHS Before It Kills Again”

“NHS managers covered up the unlawful killing of up to 650 patients at the Gosport War Memorial Hospital on the English south coast.” ~ Rupert Darwall

Gosport Hospital: The Coverup

“A couple of nurses were very concerned about the prescribing practices…but the clinicians and hospital managers said, ‘You really don’t have a right to question a clinician.” ~ Rupert Darwall

Rupert describes the atrocious, decade-long scandal at Gosport War Memorial throughout the 1990s and into the 2000s. After nurses brought up concerns about clinicians’ prescribing practices, they were shut down by hospital managers.

“What you saw was the managers and the clinicians suppressing the complaints raised by the nurses.” ~ Rupert Darwall 

The suppression of complaints by the hospital managers created a culture of silence within the hospitals. Whistleblowers were intimidated to come out and, for those who’d already blown the whistle, it became very hard to work at the hospital.

“That’s when the momentum for the over prescribing of opioids formed. The clinicians knew what they were doing was shortening of the lives of people, and in some cases patients who were expected to get better. They were being killed, they were being killed off at this hospital.” ~ Rupert Darwall

Mid-Staffs Hospital

In the WSJ, Rupert wrote, “In 2015, the Francis Report into Mid-Staffs Hospital found ‘appalling and unnecessary suffering of hundreds of people’ and warned of ‘highly concerning’ reports of similar experiences elsewhere.” 

The care at Mid-Staffs that warranted this harsh language from Francis was atrocious, lacking “care, compassion, and humanity.” Elderly and vulnerable patients at Mid-Staffs were left unwashed, unfed, without fluids, with incidents of callous treatment by ward staff. The report stated that this was not an isolated incident.

However, Rupert feels that the treatment at Gosport Hospital was worse:

“I think what was happening at Gosport was even worse. You had clinicians making the decision to end the lives, this isn’t just negligence, this goes a step beyond that to actively ending the lives of patients by prescribing fatal doses of opioids. And they knew what they were doing.” ~ Rupert Darwall 

Gosport Hospital: “A Culture of Death”

“On that ward [at Gosport Hospital] there was a culture of death.” ~ Rupert Darwall 

Rupert wanted to be very clear: “This was not palliative end-of-life-care. This was clinicians deciding that such and such patients’ were going to be ended. In fact, Rupert tells a haunting story not included in his article. A particularly troublesome patient was told by a nurse he’d better be careful or he’d be put on a syringe-driver. He was put on the driver and three or four days later he was dead.

“It is unbelievably shocking. What happened in there is black and white. It’s not speculation. We’re talking about up to 650 lives foreshortened.” ~ Rupert Darwall

Gosport Hospital: The Unexpected Death of Gladys Richards

Gladys Richards, a 91 year old female, was to be treated by Dr. Jane Barton for hip rehabilitation in 1991. The expectation was that she would be discharged. However, she was put on opioids and was dead within a week after entering the hospital for rehabilitation.

“There was no clinical need for her to receive opioids. Let alone in the quantity that killed her.” ~ Rupert Darwall

Rupert makes clear there was no objective reason for Gladys to be on opioids. In fact, the Francis Report clarifies that Gladys had no pain.

Gosport Hospital: The Investigations

When word of these occurrences started coming to light, a dozen other nurses wrote into the NHS to say they had the same prescribing practices as Dr. Barton. Rupert feels this is evidence of the culture that had developed in England.

Gladys’ daughters took the matter to the police to start an investigation. Rupert says the detective was clearly not up for the job in the investigation.

A second investigation took place with Professor Brian Livesley from Chelsea and Westminster Hospital. After reviewing the evidence, Professor Livesley said he would support allegations of manslaughter and actual bodily harm.

Gosport Hospital: A Conflict of Interests

“When the government is a provider, funder and regulator it has a huge conflict of interest. The result is patient welfare suffers.” ~ Rupert Darwall

In the time before the 2001 General Elections in Britain, the investigation into Gladys’ death was in full-swing––with the NHS as a prominent political issue. However, the police wanted prosecutors in the Gladys’ investigation to be careful not to interfere with the election.

“The result of that meeting, was the move towards prosecuting stopped at that point.” ~ Rupert Darwall 

Gosport Hospital: Dr. Barton’s Defense

The DailyMail reported that Dr. Barton sent letters to hospital authorities saying, “You can’t keep sending me this number of patients, I cannot cope with this number.” I ask Rupert if this was a viable defense. 

“If that had been her concern, why was she so hostile to the nurses who raised the issue?” ~ Rupert Darwall 

A Systemic Problem?

“Is this a systemic problem stemming from the NHS? Or are these just singular cases with no connection?” ~ Luke Scorziell

Rupert tells us this is a systemic problem that can be attributed back to the government’s dual role as the provider and funder of healthcare.

“In Britain they say profit in healthcare is evil. But a for-profit hospital does not have a financial interest in killing its patients.” ~ Rupert Darwall

There is a stark difference in how for-profit hospitals and government funded hospitals view the patient. “In the NHS every patient is a cost,” Rupert says.

Options for Reform

Theresa May’s 20% Increase?

Just two days before the Gosport Independent Panel released their report, Prime Minister Theresa May spoke on the NHS. She proposed a 20% increase in NHS spending, calling the NHS, “the model of healthcare that reflects our values as a people.”

Rupert says he thought the speech was terrible, especially in light of the scandals being reported.

May’s Constituency

A few years ago, Theresa May’s local hospital, Weston Park Hospital, was doing so poorly it was placed under “special measures.” Rupert compares this with an independent hospital that must maintain high standards in order to stay in business. There are no “special measures.”

Tony Blair’s Reform

Rupert contrasts May’s approach with that of former Prime Minister Tony Blair. In the early-2000s, Blair called for opening up the healthcare system.

United States Healthcare Reform

“If someone tried to create the NHS in the United States, there would be a revolution. Americans would not put up with it.” ~ Rupert Darwall

To contextualize the NHS, Rupert takes us back 70 years. During and after World War II, Britain was very socialized. The NHS was a by-product of that. Thus, Rupert says socialized healthcare is a severely outdated concept.

“The NHS is unmanageable.” ~ Rupert Darwall

Rupert even tells of a government report which said the NHS was “drowning in bureaucracy.”

Bills with Luke Scorziell does not provide investment, tax, or legal advice or recommendations. This material is solely intended for educational purposes based on publicly available information and may change at any time. Additionally, this article’s content is a summary of the Interviewee’s comments and, while rephrased by the Author, are not from the Author himself.

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