We British have a well-earned reputation for hypocrisy, a
claimed freedom to criticise others in an ostensibly high-minded way coupled
with an unwillingness to discuss or accept the imperfections of certain aspects
of our own society. The British are doubtless not alone in this weakness but I
would like to sketch in our peculiar, if protective, attitude to a central
institution in Britain, The National Health Service.
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| William Beveridge |
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| Aneurin (Nye) Bevan |
The National Health Service was inaugurated in 1948 acting
on the Report of 1942, chaired by Liberal economist William Beveridge, a rather
dry old stick. It had recommended the creation of a taxpayer-funded universal
healthcare system, from the cradle to the grave, free at the point of
distribution. The necessary legislation
was pushed through Parliament by the charismatic Socialist firebrand Nye Bevan;
the senior doctors, a powerful lobby bitterly opposed to the NHS, were outmanoeuvred. The Tories voted against the Act, believing that war-weakened
Britain could not afford the scheme at that moment, but there was a wide
measure of cross-party consensus for the NHS concept. The NHS remains a great
blessing for every British citizen and is the corner-stone of the Welfare State.
But the NHS is in crisis. The problems are manifold; demand
for healthcare is unlimited; there are constant new and expensive advances in
therapies; the UK population is living far longer than Beveridge and his visionaries
anticipated and old people need medical help disproportionately. The system
works at full capacity, with waiting times for non-emergency GP appointments commonly
one month, Accident and Emergency departments become overrun as patients abuse
admission criteria. Pressure on hospital beds is intense, operations are
routinely postponed, patients often lie awaiting admission on trollies, elderly
patients, (“bed-blockers”) cannot be discharged as local authority social
services do not have the resources to care for them.
The NHS employs 1.6m people (40% from overseas) and is the
largest enterprise in the UK and the 5th largest in the world. The
NHS cost the equivalent of £15bn in 1948 and this has mushroomed uncontrollably
to £117bn in 2015/16. Yet Germany and France spend substantially more per head
than Britain, not to mention Norway, while Italy and Spain spend a similar
amount. The NHS staff is militant, nurses and junior hospital doctors demanding
better pay while well-remunerated consultants and GPs fiercely oppose the
government’s wish to move to a fully functioning 7-day rather than a 5-day
system Sadly the NHS is by no means “the envy of the world” as the systems of
about 15 other countries are rated more highly while cancer and cardiac
survival rates for NHS patients are unacceptably low.
Politicians have been craven in facing up to these problems.
The Left screams constantly for yet more money to be thrown at the problem
areas forgetting that resources are finite. The Right puts undue emphasis on
“efficiencies”, cutting personnel numbers and bureaucracies which are not truly
at the heart of the problem. Together their idiotic reflex action is to
“ring-fence” expenditure and not subject it to any profound scrutiny – a sure
recipe for yet more failure.
The NHS cannot be exempted from close examination and some
hard choices. The taxpayer contributes the giant’s share of the funding,
representing about 8.8% of GNP. It is high time we abandoned the notion that
patients should make no contribution to their care. With generous exemptions
for the really poor and the very aged (say over 80s), it is surely reasonable
to extract a token £5 flat rate for a visit to a GP and say, a £20 flat rate
for a night in hospital. The true costs are of course much higher but
time-wasters, hypochondriacs and the frivolous need to be deterred from
clogging up primary care and hospital patients can usually afford something.
The treatment of the old is a major issue. Over time a
network of state-run clinics and hospitals for geriatric illness should be
erected, hopefully “centres of excellence”, separating these patients from
those in general hospitals and money should be invested in the best geriatric
procedures and relief for the helpless, maybe tapping philanthropic donors as
well as the taxpayer.
I doubt if the system whereby welfare is notionally funded
via National Insurance deductions can politically be changed, but some personal
insurance element could be introduced perhaps for unusual therapies. Although
the idea of rationing hospital procedures is fraught and emotive there must be
limits to what the NHS can provide, humanely applied.
Getting the NHS back to order is partly a managerial
challenge, partly a financial one and partly a requirement to think inventively
outside the box. The public psychology needs to move away from welfare
dependency – the idea that this is a state problem – to an acknowledgement of
responsibility by every citizen that the health of every family member, young
or old, needs particular understanding, that treatment carries a cost, and
health professionals should be cherished.
Thoughts “outside the box” must take due note of the
Hippocratic Oath. Save us from the Orwellian nightmare of an Assisted Dying
Department (“call ADD to Subtract” its catchy slogan) administering a state blue pill to the
inconveniently alive, the blow softened by an illuminated scroll expressing
thanks for past services from a grateful monarch! Worse still would be the
remedy suggested by arch-satirist Jonathan Swift in 1729, certain to reduce the
pressure of numbers, in his A Modest
Proposal:
A
young healthy child well nursed, is, at a year old, a most delicious nourishing
and wholesome food, whether stewed, roasted, baked, or boiled; and I make no
doubt that it will equally serve in a fricassee, or a ragout.
Are Theresa May and Jeremy Hunt up to this steep challenge?
SMD
23.01.17
Text Copyright © Sidney Donald 2017
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