Difficult conversation

The NHS has been likened to a 74-year-old patient who hasn’t been taking care of themself

Record waiting lists, full wards, blocked beds, ambulances queuing outside casualty departments, patients dying unnecessarily, nurses out on strike and public satisfaction in free fall.

It’s a million miles from the confidence of 1948 when the service was founded, as part of a radical government plan to rid the nation of ‘disease, ignorance, squalor and idleness’.

The debate about where it goes from here has not been short of contributors – politicians, think tanks, NHS staff, journalists and many more, have all had their say. It has even been suggested that a citizens’ assembly should be set up to determine the future of the health service.

With few exceptions, they talk about a lack of resources – hospitals need more beds, wards need more staff, staff need higher wages – and, in the background, the Government is dealing with some of the most challenging economic conditions we have ever experienced as a country.

Those who propose spending more money on the health service inevitably cite a ‘special case’ defence, when it’s pointed out there is no more money. They accept that budgets are tight, but surely extra can be found, because health is not like other government departments.

There’s an impenetrable, circular logic to public discussion of the NHS that makes criticism impossible, leaving sceptics craving a darkened room in which to lie down.

At its heart, is the argument that any attempt to improve the health service by means other than additional public funding is secular heresy.

Efficiencies welcomed in other areas of public service like eliminating waste, merging duplicate provision, seeking cheaper alternatives, automating processes or – lord forbid – involving the private sector – are immediately denounced as equivalent to ‘profiting from sickness.’

Last month Sajid Javid, the former secretary of state for health and social care, became the highest profile figure yet to question whether the NHS can survive in its current form, or whether we should now confront the option of making some people pay for some provisions.

Javid, who will stand down as a Tory MP at the next election, suggested the possible introduction of a fee being charged for certain appointments.

Such charges exist in some other European countries, for example in Norway patients are required to pay around £20 to visit their GP, while in Ireland the cost of attending a hospital A&E department is around £75.

The reality is however, that injecting extra money into healthcare provision, even if it was available, would do little to improve performance because – and even its staunchest supporters agree – the NHS is a bottomless pit.

At the start of his second term as prime minister, Tony Blair committed his New Labour government to matching European levels of spending on health, rising from seven per cent in 2000, to more than nine per cent by 2008.

To give you an idea of the scale of this financial outlay, it entailed, by 2003/04, spending £63.7 billion on the NHS with, by far, the largest proportion going on staff wages.

And the result? Writing in The Lancet in May 2007, Hannah Brown said: “Ten years of New Labour health reforms have injected badly needed funds into the UK’s National Health Service. But through repeated restructuring and micromanagement, Blair’s government seems also to have eroded clinicians’ flexibility to care for patients.”

To accompany his high spending, Blair’s reforms amounted to introducing an element of competition among different elements of the health service, but with the crucial proviso that outside competition from the public sector remained verboten.

By 2015, Phil Whitaker, writing in the left-leaning New Statesman – in an article headlined ‘How Labour broke the NHS’ – concluded: ‘Labour finds itself in an embarrassing position: the party that began privatisation has to explain why that process – which has, after all, resulted in improvements in the elective-care arm of the service – is simultaneously incompatible with meeting the present-day challenges the NHS faces.’

Making decisions that appear sensible at the time but which later turn out to be foolhardy is not, of course, restricted to politicians.

I recently unearthed an article from the British Medical Journal (BMJ), from 2008, where The BMA (British Medical Association) had just voted, albeit marginally, not to increase the amount of medical training in the UK because, they thought, it would devalue the profession and suppress wages.