Here's a scary thought – what if there was no way a government could ever create a health service that we felt safe and secure about. If, no matter how much money, how much management expertise, how much research was lavished on it, it was inevitable we, as a society, would see the health service as failing us.
There's a psychological argument that suggests that this, is in fact, the case – we see the health service as failing, because we need to see the health service failing. Why? Because if we didn't think it was failing us we'd be faced with the horrible fact of our own mortality. And nobody wants that.
Francois de La Rochefoucauld said that thinking about death was like staring at the sun – you can't do it (he said it rather better, and in French, but I'll just take the metaphor). Thinking of the inevitability of our own mortality is a very uncomfortable thing and therefore we avoid it. So much so that if someone who is close to us dies then most of us will seek out a reason and explanation.
Very few of us will be content with the idea that someone died because they were old and that's what old people do. Or because they got cancer and there is simply a percentage change that any of us could develop cancer on any day, no matter what our life-style, diet or exercise regime. Or they died because it was a risky operation and it just happened that they were unlucky. Generally we need to find a reason – a specific reason, a specific reason why this particular person died in this particular way. Therefore we come up with a theory, a story that tells us why. We may put it down to their diet, the fact that they used to smoke, or… the fact that the health service let them down. We can't just accept the fact that sometimes people just die – why? Because if we accept it was something that 'just happened to them' then it's something that 'could just happen to us'. And that's terrifying.
The fact of our inevitable death is very uncomfortable, so when we see the death of another person we may need to reassure ourselves that 'it didn't need to happen'. We tell ourselves it could have been avoided. We tell ourselves that it was someone's fault. That if the health service was better run, or better funded, or if the managers were doing a better job our friend or family member wouldn't have died. By doing so we are trying to convince ourselves that perhaps death isn't inevitable, perhaps it can be cheated when its our turn, perhaps if we complain and protest enough someone will come along and fix the health service properly so that we don't have to die.
None of this is to deny there aren't real problems. Of course having a better diet decreases your chance of getting cancer, and quitting smoking decreases it a lot. But it doesn't remove it entirely. Cancer is just one of those things that happens, it's random and entirely unfair. Likewise a hospital can be run better, doctors can improve the way they perform operations and managers can improve the efficiency and effectiveness of the organisation. However, it'll never be perfect.
And perhaps we need to always see it as imperfect, as flawed. Perhaps we always need to criticise the health service, and always feel a little bit let down by it when someone we know dies, so we can look at its imperfections and avoid having to stare at the sun.
[Sadly I can't claim this idea as my own. It was mentioned to me at a party by a friend, but despite extensive googling I can't find out who the academic was who originally suggested this theory. If you do know where it originates from do drop me a comment.]