The politics of reform of the NHS have never been easy. It was not easy for the Blair government that I was a small part of and it has not been for the coalition government.
But running away from that controversy has now placed the medium-term politics of the NHS in a very odd place.
Between now and 2020 both main political parties have pledged to:
- maintain the basic principles of a free service paid for out of general taxation with equal access for all
- not have another ‘top-down reorganisation’
- keep to the same level of resource
- recognise that there will be an increase in demand from older people with long term illness of about 20 per cent
- create a new universal coordinated care model to abolish the fragmented health and social care services of the moment
And all of this is apparently going to happen without any major reforms of the existing system.
This drives leaders within the NHS to distraction since they know that all of these goals can only be achieved with a great deal of change.
That is why today’s pamphlet from Norman Warner and Jack O’Sullivan ‘Solving the NHS care and cash crisis’ is such an important contribution to the future of the NHS.
The main political point that they make is that if you genuinely love the NHS and you genuinely want to see it thrive over the next 30 years, then you have to help it make some very hard choices and provide political support for it when it makes those choices.
If on the other hand you are frightened of the political controversy that real change and reform will create and that leads you to defend the status quo for the NHS you are probably defending the NHS into an early grave.
Warner and O’Sullivan outline one of the first real political arguments for overall reform of the NHS for over eight years (for reasons I never understood Andrew Lansley never really constructed an argument for his reforms).
There will be a row. And that will be a good and necessary row.
The changes to the health and social care model of delivery they argue for are thorough. They recognise that many of those places that we call hospitals will be providing health care in the future, but in a very different way.
But the main controversy will be about funding. They argue for extra resources for the NHS that are to come from three sources
- taxes that are health improving
- taxes related to health consumption and ability to pay and
- changing entitlements and increasing co-payment
Politically the first two will appeal to the left and the third will horrify the left.
Higher taxes on alcohol could provide hypothecated taxes just for the NHS.
An increase in the percentage of people who pay inheritance tax could go to the NHS.
They then argue for changing universal entitlements and some limited co-payments.
I do not agree with these three points for very different reasons.
I think any limitations of entitlements for the NHS and introduction of co-payments will begin to hack away at the strong popular sentiment that exists for the institution. And, being the same age as the NHS, I do not want that to happen.
But my worry about ‘finding more money for the NHS’ is that the very promise of more money will once more reduce the pressure on the NHS to change the way in which it provides services.
The innovation that will be required from the NHS and social care to follow other services and provide significant better outcomes for the same resource will be diminished if more money is uncovered.
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Paul Corrigan was a health adviser to the last Labour government
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Photo: Chris Jones
In 2010 the NHS scored its highest ever public approval and was, according to the internationally respected, Commonwealth Fund the fairest and most efficient health system in the world. Compared to other developed countries the UK spends a comparatively small amount of GDP on healthcare so I really think this resourcing and structure issue is a red herring.
If we really want to save the NHS and help more people live healthy and happy lives we have to get to grips with public health in the broadest sense. By reducing, or at least offsetting, demand we can save money, misery and lives.
Poverty is the number one cause of poor health and Labour should resurrect its pledge to eradicate child poverty as a national campaign that the whole country owns – not just clever people in the Treasury tinkering with tax credits.
Stopping smoking in public places was one of the great public health achievements of the last government and we should build on it with plain fag packets, minimum booze prices, a ban on alcohol advertising and more power to councils over licensing.
Social and emotional education in schools is found to save £84 for every £1 spent and Labour needs to reinstate ‘wellbeing’ to the Ofsted inspection regime and ensure every pupil knows how to look after themselves and their peers. We need to reinvigorate SureStart and ensure that the most vulnerable get decent housing, support to be great parents, a Living Wage job and a sense of hope and community. We help the NHS most effectively by helping people look after themselves better in a fairer society.
People will be willing to pay highter taxes and NI if it was to go onto the NHS. It would also help if the parties took serious action to tackle tax avoidence and evasion too. However introducing charges for healthcare is vile, wrong and against everything the Labour Party stands for, even a Blairite one.
The trouble with the approaches to the NHS by both Labour and the Coalition is that, whatever the public utterances of their politicians, they are both neo-liberal. They have been teeing the NHS up for privatisation in the long term, with their book-keeper’s and limited budget attitudes and disregard of the actual welfare of the actual citizen. The word “Choice” is part of this programme.
The aim should be excellence in medical practice all round, not in terms of meeting financial or volume targets set by managers with no medical qualifications and inhumane attitudes. Top down stuff – NO.
Bottom up planning can, surely be done with innovation and cross-Governmental Department initiatives to promote well-being. Management of the NHS should not be like that of a fast-moving consumer goods factory (which it has tended to become in recent years), but should be recognised as that of a group of highly-trained professionals.
The review of Henry Marsh’s book by Euan Ferguson in last Sunday’s Observer
(www.theguardian.com/books/2014/mar/30/do-no-harm-stories-brain-surgery-review-henry-marsh) shows the extremely difficult profession medicine is and the skill it needs to practise it. The review also mentions the unspeakable NHS manager who threatened Mr Marsh with disciplinary action for wearing a wristwatch on his rounds.
The Department of Health should also recognise that a GP, in particular, is in the front line of psychiatric care for the population. A seven-minute time ration for a consultation is abhorrent as a norm at a time of breakdown of social solidarity and, indeed, a national lack of psychiatric care. It is wrong to put the patients on a conveyor-belt and any financial incentives for doctors to do so should be discontinued.
If the UK has to double spending to get a fit-for-purpose NHS (and raises taxes accordingly), then so be it. HM Treasury and any Chancellor of the Exchequer who happens to be around ought to be well and truly apprised of what their priorities must be and what the wider public demands. And while we are at it, we could tell them to cool off their Enron-style financing mechanism of the PFI and to restructure the public finances so that individual hospitals are not diverted from their vocation of care by handicaps arising from by bogus financial schemes invented by snake-oil merchants.
As a footnote to my previous comment, I add that there is a longer review, by Erika Wagner, of the book: “Do no harm: Stories of Life, Death and Brain Surgery” by Henry Marsh in the New Statesman of 20 March. (www.newstatesman.com/lifestyle/2014/03/life-and-death-at-his-fingertips-watching-brain-surgeon-work )
This goes into more detail on aspects of the work of a surgeon and on the NHS. Mr Marsh is outspoken about the changes in the ethos of the NHS.
“…..but now that the NHS is being privatised by the dumb fucks who run the government….”
Paul Corrigan, take note.