January 13, 2015 by Paul Goldsmith
First of all, let me get something straight. Labour has every right to use the NHS as a political football, just as the Conservatives have every right to use the economy as a political football. If the Conservatives had a good answer to Labour’s accusations that they are running the NHS into the ground they would not have resorted to complaining about the subject being brought up. The NHS qualifies for political-football status as it is politicians who are responsible for it. It is the largest employer of people in this country (1.7million people) and is responsible for the nation’s health. Our ageing population means that it is going to become even more important over the next few years. It is also vitally important to the British psyche and view of themselves, being more than just a health service, but a creation of which we should always be very proud. Therefore, if Labour wish to argue that they would be better custodians of it, that is fine with me.
The concept of health treatment for everyone, free at the point of use, is like a religion in this country. There are economic justifications for this, in that a healthy country is a productive country and health care for free makes the UK a fairer country too, given the ability to get healthcare should never be dependent on means. However, there are also economic justifications for having constant vigilance on whether the model for providing healthcare actually works in the best long-term interests of the British people. What if there were a better way? This is where politics becomes a problem, because it stops sensible thinking of how we ration our healthcare to make it work.
Ration healthcare? Surely some mistake? How can you ration keeping people alive? How can you ration saving ill children? Well, that’s not what rationing actually means in an economic sense. Rationing means finding a way to help demand for healthcare meet the supply of healthcare through giving the consumers the incentive and/or the information to think about whether they actually need to consume it.
As a simple example of this, the recent A&E crisis is partly caused by the reality that about 40% (some NHS professionals say it is nearer to 50%) of those who are arriving there shouldn’t be there. They may have conditions, such as a sprained ankle, which are neither accident nor emergency, they may be wanting to get their child’s cold to be seen to outside GP hours so they can go to work the next day, or they may just be drunk. If we can cut this down, that would help.
On the supply side, the ridiculously craven capitulation of the Labour government in 2004 to the GPs, in which for a tiny salary decrease they didn’t have to work evenings and weekends, means there are swathes of time when medical is needed and the only place to get it is the 24 hour local A&E department. Talking of Labour initiatives, the idea to give hospitals a waiting time target for their A&E departments of 95%, which is higher than almost all developed countries, was an honourable aspiration, but one with some unintended consequences. Someone comes in with that sprained ankle, they HAVE to be seen, whether they need it or not. It used to be that the triage nurse could say “give it a day and see if it hasn’t got better”, with it many times doing so, releasing pressure on A&E.
Another initiative that Labour brought in (but are being rather quiet about at the moment) is the contracting out of some of the delivery of healthcare. This may be some repetitive procedures that they can trust a private sector provider to do, thus again helping to relieve the strain on the publicly provided parts of the NHS. This was a Labour initiative, yet it is Labour crying ‘privatisation’ at the continuation of this by the Conservatives. Whilst we are on the subject, the failure of the private company Circle to successfully run Hinchingbrooke hospital (which had been in debt when they got the contract) is being blamed on the Coalition when it was Labour (yes, you Andy Burnham) who had filled the shortlist with solely private bidders anyway. My objective here is not to point the finger at anybody, but rather to show that the NHS should be a political football which is shared by all serious political parties, who should work together to make it run best.
That means considering every option. Every option for delivery, funding and indeed rationing. The fact that no-one is even allowed to bring up a comparison with France, where every visit to a GP costs €23 euros (70% rebated to those with means, 100% rebated to those without), thus at least making people give even a little bit of thought over whether it is necessary, without being seen to have committed political suicide (Nigel Farage 2012), is a disgrace to the quality of our national discourse that should have JS Mill turning in his grave. Mill believed that encouraging dissent has two benefits – the consensus finds out they were wrong, which benefits all, or the dissenter finds out they were wrong, which leads to more robust ideas being delivered.
The Tories have said they will protect health spending, but that doesn’t mean they have to raise it, yet raising it is needed, by about £30 billion over the next six years. Labour will pretend that their “Time to Care” fund, in which they indulge in some populist rich-bashing to give £2.5bn a year to the NHS, is enough, but it isn’t. Simon Stevens has said in his review of NHS funding that nothing short of £8bn a year will suffice. Nothing will work without a major increase in productivity, and that may include involving incentives that can only exist in the private sector as well as helping citizens to think about whether they really need the time with the GP or the A&E department that they are demanding without thought to the consequences. It means thinking, and building on each others’ ideas.
Andy Burnham is doing that thinking, proposing a joining together of social care and health care so that our elderly, who will be increasing in number inexorably are given coherent care where they most need it. At the moment, many elderly people come into A&E for treatment, then have to be kept in on a bed until they can look after themselves again, as the lack of link between health care and social care means that they can’t get treatment at home that they need. Furthermore, whilst they may have ring fenced health spending, Coalition local authority cuts have reduced the care an elderly person can get at home. This led to almost a million days of people lying in bed in hospital last year instead of being at home where they could be should sufficient care have been available. This needs to be solved.
What cannot go on is the insistence of shutting down debate that has led us to the point where the Guardian can seriously say, in a report on Britain’s healthcare rankings that “The only serious black mark against the NHS was its poor record on keeping people alive.”
THAT is not the way to protect the NHS from change.