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The Disraeli Room

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Nothing in life is free – not even the NHS

9th January 2015

It’s that time of year, when rising demand meets NHS spending limits. Why has this become such an annual – and unwelcome – winter event?

The NHS raises passions like no other state organisation in the world. It stands like a beacon for its supporters of what can be achieved through the exercise of human will, a statement of intent for all who subscribe to a belief in some form of socialism. For its detractors it is a monolithic over-protected example of spending gone mad, of the bloated nature of the old state industries, long overdue for dismemberment into a more rationally – market based – led system.

Emotion feeds this debate, as much as politics. We all have ‘our’ story of the NHS. I was saved by its early ministrations, when very young and very ill. My children were born in its decaying but somehow warm and welcoming delivery rooms. My youngest was later the recipient of the care of an ambulance crew who turned round from their way off shift to come and back to fetch him.

On the other hand a girlfriend came within forty minutes of dying because an anaesthetist could not be found on a bank holiday weekend for her emergency operation. The result was eventual survival, but at a terrible cost to her. Other failures, involving one self or relatives, or friends, at other times, would be laughable, if not involving real health concerns.

My eldest son, just short of qualifying as a doctor, tells me that, nevertheless, the service continues to stagger on, tipsy with its own successes, but not quite yet, too drunk to carry on. Asking his colleagues to give details of where it is failing produce blank stares, even as they assert, along with so many others, that it is failing, and failing hard.  Like patients and, more usually, politicians, clinicians have an obvious vested interest in asking for more money to ‘save’ the service. The question is, though: is the current crisis real?

Politicians have a curious role to play here. Out of government, they harry the service, seeking its weaknesses and blaming the present government for any failures, even as far down as individual care or operations gone wrong. In government, the NHS is ‘safe in our hands’. The public increasingly believe only what they see with their own eyes, and what relatives and friends tell them.

The NHS was set up in an entirely different world to that of today. Many of the big health issues related to public health. Childhood diseases, such as diphtheria and measles – third world diseases today – killed and crippled many of the young. The old died much earlier, and operations like hip replacements were decades in the future.

But the success of the NHS in treating, then curing, and finally largely eliminating many of these diseases, coupled with huge advances in medicine, worldwide, has led to a crisis in demand. That demand is growing all the time.

Some early principles, like fully free prescriptions, were also early casualties, although it should not be forgotten that, among others, children and the old still get their medicines entirely free. But the range of treatments available, along with a growing – and ageing – population has meant that the NHS has been constantly running to catch up with both medical advances and the concomitant demand.  That race was lost from the beginning. Healthcare demand will always outstrip supply.

Healthcare is a not a ‘normal’ commodity. Like education, it has very strong moral precepts attached, making it a basic human right. When you are taken ill, all you want is to get better. The actual interaction is between patients and clinicians, and the NHS was set up to facilitate that. It is not a buying and selling opportunity, except at the margins (cosmetic surgery, for instance).

It can be argued that, in a frenetic consumer society (Christmas shopping is the perfect example), we have lost sight of the difference: our demands on the service are too strident. If this is the case, throwing more and more money at the NHS will only fuel the problem, increasing the flames of demand for no extra rewards.

We need an entirely new kind of public health campaign established, from schools and beyond to the adult public. This would teach all of us, first, how to be healthy, how best to remain so, and, second, how to use the NHS wisely. It would be an integrated sustained approach and it would remain at the heart of all future healthcare policy.

Second, we have as a society to find a way to remove politics – and thus politicians – from the heart of the NHS, from their constant interfering ways, from dabbling in on the hoof healthcare policy to the detriment of all. Some form of overall NHS Trust needs to be set up, perhaps along the lines used by the BBC.

We have become blasé in our attitude to what remains the world’s original model of free healthcare. As a result we have become used to abusing the privileges that go with the NHS. We need to be reminded that nothing in life is entirely free. The paradox we have to overcome is that only by paying something extra, will we be able to continue to enjoy a fundamentally free healthcare system.

4 comments on “Nothing in life is free – not even the NHS”

  1. Vern Hughes says:

    Reforming health care policy is arguably the most difficult area of policy reform. The stalemate between neo-liberal privatisers and statist monopolists is a hard one to crack for reformers. The solution is not difficult, in theory: replacing state-centred, bureaucracy-driven provision with a system of competing mutuals of consumers which purchase and coordinate care for consumers without provider-capture of services. But this Third Way in health care remains surprisingly difficult to conceptualise and popularise.

    The number of grass-roots advocates for this course remains small. And the cooperative and mutual movements, who ought to be the natural supporters of this approach, remain stuck in the state provision paradigm in defiance of their own traditions.

    In both the UK and Australia, ation

  2. Jenny says:

    Thanks for Dr Madge’s gently provocative blog, which sets many hares running. The one I would like to address is: our faith in our Rights. We do, of course, contribute to our NHS but, unless this is regularly matched to expenditure, it fails to uphold our Rights. As Dr Madge points out: the very excellence of the Service has created more demand; it follows that we must now assess how users should contribute to the unimaginable benefits of the idea of ‘free’ health from cradle to grave.

  3. Jenny Wright says:

    Dr Madge raises many hares in his gently provocative blog. The one I should like addressed is: Our faith in our Rights. Don’t Rights involve Responsibility? We do pay towards the NHS but is it enough? Dr Madge points out that the very excellence of the Service has created ever-increasing demand; surely it is time for an assessment of how much health we can expect to be given free from cradle to grave. It is a pretty universally acknowledged truth that humans usually appreciate something the have earned more than something that is free

  4. Eric Green says:

    I agree that the politicians need to be removed from running the NHS, this is the only way we can give it clear direction that is guaranteed not to change every few years. However I also feel that the link between what we pay for the NHS and the individual needs to be restored. We should look at National Insurance again so people see the link between what the NHS costs and what they get and also the benefit system costs and what they get. This would also show what good value the NHS we have is.

    Procurement of services by groups as suggested may work in the populous areas of the country, however for many parts of the country this would undermine what service there is. Local control of the NHS and all other public services is the way to go. Let local people develop the services that suit their community not a centralised system that dictates.

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