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Posted by Dr No on 08 January 2010

creep.jpgThe ever-interesting Witch Doctor has made a welcome return to the blogosphere. It seems that while she was away in the witchosphere, she spent time contemplating one of her persistent themes – that of creep. The Witch Doctor, she says, believes in creep. So does Dr No. But, it appears, not everyone is familiar with the term as the Witch Doctor and Dr No use it. A little while ago, one of Dr No’s confidants – a well read and intelligent woman - was reading a post and remarked on what she read as a grammatical error. Dr No had missed out a subject to the verb creep. She had not before come across the word creep used as a noun to describe a social process. Dr No wonders if there may be others unfamiliar with this usage.

Given the centrality of creep to the views of the Witch Doctor and Dr No on the way things are going, it seems sensible – to Dr No at least – that it is clear what is meant by creep, as used by Dr No and the Witch Doctor. He apologises in advance to those who are already familiar with the concept for telling them what they already know. They may however like to ponder some of the examples Dr No will provide of creep – and ponder the extent to which they themselves have already been subject to unwanted creep.

Creep, as used here, is the social process by which large and regrettable social change occurs by a series of small, often imperceptible steps. It is characterised more often than not by passivity, in that it happens not so much because someone intends it to happen, as by a societal failure to stop it happening. All too often it involves a subtle desensitisation to the unwelcome nature of developments: were the whole change be introduced all at once, there would be an outcry; but as it happens through imperceptible steps, there is a collective failure to appreciate the direction in which the creep is heading. And it frequently opportunistic: a measure introduced to achieve an apparently neutral aim is in time extended to an altogether more sinister purpose.

Creep is manifest in Martin Niemoller’s ‘First they came for the communists…’. It was manifest in the Nazification of Germany, culminating in the Final Solution.

More recently, and closer to home, it is manifest in:

• Retention of innocent individuals records on the National DNA database

• Spurious arrests to extend data held on the National DNA database

• The burgeoning use of CCTV cameras to make the public “feel more secure”

• The use of anti-terror law – the Regulation of Investigative Powers Act (RIPA) - to track down minor crimes

• The pilot introduction of identity cards (and – Dr No can’t resist this link - the loony own goal promotion)

• Police surveillance of ‘domestic extremists’ – a term which has no meaning in law

• The extension of the Vetting and Barring scheme to millions of guilty until proved innocent members of the public

And so on. And on, and on. In medicine creep is manifest in:

• The Liverpool Care Pathway for the Dying

• The Mental Capacity Act ‘forcing’ doctors to allow suicide

• Inadequate inquests masking passive involuntary euthanasia

Compulsory revalidation for doctors by a state appointed quango

• Appraisal transformed from a confidential process into an identifiable centrally retained record

You have been warned. Be afraid. Be very afraid…


Creep is extremely dangerous. It prevents you seeing what is happening. Last week I had an elderly patient with an accent that was obviously German. I spoke to her in German (not that her English was bad). She immediately replied, in English, that she never wanted to hear 'that language' again. And she then explained why. Needless to say she had lost countless relatives in the holocaust. It is a story Dr Grumble has heard countless times. Dr Grumble's patients were lucky in that their parents had taken them out of Germany in good time. Why didn't the other Jews leave? Was it because of creep? Each change introduced by the Nazis was slight. They crept. It was like a lion creeping up on its prey. Tiny forward movements are not noticed. That is creep. If you cannot see it you cannot extrapolate and see where things are heading. It is a way of implementing policy without discussion or debate. The privatisation of the NHS is an another example of creep compounded by deliberate obfuscation. Many I speak to are bewildered at my suggestion that the NHS is being privatised. The significance of contestability, plurality, choice, Choose and Book and care records on line has passed them by. Consequently there has been no public discussion or debate on the privatisation question and it seems there never will be. Privatisation of the NHS is not, I think, what the public wants so the only way New Labour or old Tory can achieve it is by creep. Creep is clearly a very successful way of introducing policies which the public will find unacceptable.

Some of these changes might be the right thing to do but they might not . But because they are not on the common man's radar no public views are aired and the policies are just implemented - but very slowly. It is actually quite clever but, as I said, very dangerous.

Initially, I thought this a wonderful caring thing, but now I worry about it an awful lot.

The first experience of it was of a lady returned to us from hospital. She died within twelve hours. She didn't appear 'that bad' when she was admitted to hospital, but was found to have a terminal illness. She must have deteriated rapidly in five days to meet the criteria for the pathway. Sadly, she died on my day off and I never had the chance to apologise to her. I had bought in to the original diagnosis of behavioural problems.

Second time, a man, who despite three attempts to treat his pneumonia with antibiotic therapy, continued to fail. He was placed on the ICP and I think it was totally appropriate. He died a peaceful, painfree death.

Third near experience. An elderly lady with a presumed carcinoma. Her family requested no aggressive treatment. She was kept pain free on diamorphine. She died peacefully in her sleep three months after meeting the criteria of the ICP. We did not request or suggest she be on it.

I worry that we could of. I worry that folk who might recover are not given the chance too. I worry that its original (good intentions) are misused and abused. I worry that is easier than attempting to treat.

It IS a creep.

Dr G and Nikita - thanks for your examples. The more the merrier - so come on the rest of you - get posting!

Creep is certainly very very dangerous - something I didn't spell out as explicitly as I should have done in the original post. I suppose I took it as read, which of course is never a good idea.

What I am still working on is the extent to which creep is purpose (final goal) driven, as opposed to being a passive and/or opportunistic process. Or maybe it can be either?

Take the Nazis - did Hitler in the early 1930s - when he had certainly spelt out the 'Jewish Problem' - already have in mind the Final Solution, and then purposefully implement the steps to get there? History suggests probably not; it was more that each individual evil step facilitated the next evil step, and in time the Final Solution became possible. If this is the case, opportunistic creep is even more dangerous, because by definition no one knows where it is headed, and where it will end up.

I have been reading quite a lot of a little known, I believe, Creep exercise going under the assuring title of 'Commom Purpose'.

It recruits and trains "leaders" to be loyal to the directives of Common Purpose (CP) OR does CP stand for Creep?

Slowing we are creeping due East and the year seems to be 1984!

Locally (Solihull) phlebotomy services are now available at Boots in the town centre, and the local hospitals no longer provide hearing test and hearing aids, have to refer to Dolland and Aitchison, Specsavers and other opticians for this service, funded by the NHS.

Not sure if this fulfills the definition of creep as it's a bit bleedin' obvious how things are going to be in the future!!