Whose NHS?

What’s it worth to you, this National Health Service of ours? Are you a true believer in its virtues? Are you essentially agnostic? Or might you indeed deem the NHS to be the work of the Devil? Of course this issue of the imperfections of our health system became banner news over the summer of 2009 owing to President Obama’s healthcare reform travails. The flat-out moronic element amid the opposition to Obama, as given a prize platform by Fox News, unwisely mouthed off about the communistic horror of Britain’s ‘socialised medicine’ and, quick as Dickens, I – just like you, I’m sure – started getting emails from friends and strangers proclaiming ‘We love the NHS.’ Both Labour and the Tories, meanwhile, acted like they would prefer to talk about something else.

Don’t get me wrong, I like the NHS a great deal, but there’s a debate we all need to have – a debate that isn’t moronic or wicked even though Fox News are among those who would wish for it. ‘In a world of ageing patients, explosive medical costs and galloping scientific advance,’ John Lichfield wrote in the Independent, ‘there can be no such thing as the perfect health service.’ Quite, and that’s why we haven’t got one.

But I have not a moment's quarrel with whatever is my National Insurance stake in the NHS (about £300 a year, I think, though people seem to perceive it as much higher). That is a bargain in anyone's language for the essential services rendered (sometimes frustrating, more often invaluable.) Two months ago my wife gave birth to a baby girl, this after months of hospital appointments with specialists and consultants, blood tests and bloodwork, nuchal-fold and chorionic villus sample tests, umpteen ultrasound scans... After two nights in a hospital bed she was home and then received a dozen midwife/health visits. For these services we received no bill. (If we lived in the USA and didn’t have maternity insurance we might have been stuck for $10,000.) A bargain, and a precious one, simple as that.

I might say that on the second night of my wife's post-natal hospital stay we decided to get her one of the little private bedrooms on the maternity ward so she could be assured of the peace that would aid restful sleep. That cost £100 - perhaps a little over-priced, but that was our choice, and it did the business. I can't say I have any quarrel on paper with the extension of other such chargeable choices through the NHS system. (I can well remember Boris Johnson's idiotic complaint in public about how he'd been unable to procure an extra slice of toast on the ward after his wife was resting up post-labour. Oh, how the free market wept! Clearly Stalin stalks the halls of London's hospitals! Putting a price on toast would be worth it if only to give a further reason for Boris to shut his gob.) Charges, made transparent at the point of access, merely supplementing what could and should otherwise be a good-enough 'free' service, seem hardly a cause for controversy - rather, a solidly good idea.

Our not-quite-‘free’ service isn’t always a good one, but that’s not the main reason why we can’t go on funding comprehensive health care through taxes alone. It’s because even the not-always-good not-quite-‘free’ service could die the death of a thousand cuts unless one makes some strategic incisions now, permitting extra infusions of private-citizen money into the bloodstream. The ongoing duty of care to the elderly and infirm, most of whom will have paid into the system all their lives, is precisely why the rest of us need to look at how we keep the system functional before we ourselves are old and infirm and at its mercy.

The money is the thing, because the NHS now faces the direst financial straits since its establishment, according to The King's Fund and the Institute for Fiscal Studies. The costs allegedly run at £105 billion a year. What are the greatest drains within that? Admin and management consultants? Big Pharmaceutical drugs? Doctors and nurses? Foreign nationals nipping in for IVF treatment, non-tax-paying economic migrants bringing the kids? Timewasters, the obese, smokers and drinkers, even if they be tax-payers too? All these play a part, I’m sure, but percentage-wise the chief layout is salaries, isn’t it? Pay and pensions for 1.5 million employees, plus the pensions of those millions who have worked in the system over the last three or four decades.

Our present deficit is such that no-one seriously denies the need for some public spending restraint. We won't go broke, but we can't stay this indebted. The tragedy here, as Phillip Stephens of the FT noted, is that of course the NHS really needs to spend more: ‘Given its demographics, Britain will need to devote a rising share of its income to health.’ But if the state must cut back, there is only one other option, right? As Stephens put it, ‘One way or another, patients are going to be asked to contribute directly to their care.’ I can't really see any other way round it, myself, call me myopic - and so I would like to hear a good and reasoned argument about how and where that charging would operate.

There are some things about the NHS that are sacrosanct. I don't think staffing levels are one of them - or rather, not current staffing levels, or, if you like, allocation and distribution of human resources in the grand scheme of the organisation... We need more qualified doctors, that's for sure. And anyone who lays hands in order to cure should be considered pretty well essential in a hospital. Even though it puts me in company with all those pitiful boarding-school-educated Tories, I'd happily see the return of ward matrons, keeping good order. On a related note, I wouldn't want to lose any cleaners.

So who is deemed expendable? McKinsey filed a report in the summer arguing that 110,000 NHS posts should be cut, including those of "frontline health-care staff." That's too frightening for words, and neither the Government nor the Tories backed the suggestion. Indeed health minister Mike O'Brien got his gloves on: "We have created 80,000 nurses jobs and 40,000 doctors jobs and you think we're going to cut them? Labour created the health service, we want to see it improve." That was classic from-the-gut (or knee-jerk, if you like) Labour/NHS tribalism. So where did O'Brien think the needful savings would be found? 'Focusing on quality, focusing on innovation, focussing on the way in which we improve service will reduce the overall cost without reducing the number of staff.’ No, I don't think he really believes that will do the trick either. But the alternatives are not palatable, even for the Tories, with their Party's traditional hatred for what it sees as the unforgiveable mediocrity and inadequacy of everybody else.

David Cameron has - quite sincerely, I'm sure, and by wisdom dearly bought - been most insistent that the NHS is safe and beloved with his Tory party. MEP Daniel Hannan's embrace of the Fox News platform need not be blamed on Cameron. But he is responsible for this parliamentary party of his and what they'd do in government. Andrew Lansley, the Shadow Health Secretary, tried in rebutting McKinsey to nonetheless applaud the projected slashing of ‘the bloated health bureaucracy.' Yes, I'd be for that too, if I thought it would make such a vital difference, rather than just playing the game of kick-the-faceless-bureaucrat. But no, it's going to take a sight more than reductions in admin costs, isn't it? Tough choices all round.

What proposals have you heard for charging? I’m already paying a whack for my prescriptions these days, such as the tendonitis I’ve got from over-carrying my kids, or the intestinal infection my GP diagnosed that, it turned out, I didn’t actually have… But nationwide these sorts of charges must be throwing more into the pot? There could be a separate budget column labelled Unnecessary Antibiotics for the Middle-Class.
I know the Social Market Foundation suggested patients should be charged £20 to see a GP. Wrong on the face of it, if it deters the poor or the anxious elderly, but then isn’t there a way to make such charges reclaimable? Isn’t that an element of the French system? The vulnerable allure of it is that it would help to get shot of Those People who needn’t really go to the doctor. And shot of them we need to be, somehow… McKinsey reckoned 40% of patients in any given hospital didn’t need to be there. I know... which 2 out of any 5 would that be? Me? Thee? Or Them? You can look around a surgery waiting room or a hospital ward and form your own opinion. Of course, it’s the medical professionals who’ll know better, and it's their time that is of the essence. I’m assuming most of them would naturally want to be part of this debate too, and I personally am really keen to hear any and all opinions - other than the one that goes ‘It’s OK just as it is...’