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James Murphy © 2002


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There is no nice way to put this. Now, more than ever, the pursuit of better health for the people of Britain through the provision of better health-care is being actively subverted. Not, at heart, by financial restrictions. Not really by persisting managerial inefficiencies. Not by the lingering hangover of Thatcherite cost-cutting. But, most emphatically, by the sentimentality of the Left.

The NHS, as originally conceived, is no longer a functional model by which to treat illness or make people healthier. But to too much progressive opinion, it is still the jewel in Labour’s crown; still the great ideological comfort-blanket; still the living thump of the socialist heartbeat. It is the one major attachment left for radical opinion to break. And the break is now overdue.

Ancestor-worship is not a good moral agent within any form of policy-making. But truly this is all that is holding in place support for a health-care system that is transparently inadequate to modern requirements. A few weeks ago, Bernard Kouchner - someone of perfectly robust progressive credentials - called the NHS "mediaeval". He is absolutely right.

A national health system where the bulk of revenue is raised through conventional taxation and where the principle of "free at the point of need" still rules is simply - however ideologically beguiling it all sounds - not good enough any more. The Government spends an enormous amount of energy trying to drive new efficiency into the NHS system. Contrary to what some critics say, it struggles and it strains to make the system better : seriously more investment, more long-term spending targets, more managerial devolution, more performance obligations for hospitals, ever more patient-empowering initiatives… The latest ideas on public – private collaborations should be seen in this light too. It is not that the Government does not like the NHS. It is that it likes it too much.

But the Government is also a prisoner of its own supporters. How much spiritually healthier it would be if we all faced the fact that a lot of the service within the NHS is an absolute atrocity. We are not saying that there are not great nurses and doctors who, driven by the highest professional motives, perform therapeutic heroics every day. But, let’s get real here. A lot of A&E provision, for example, is hellish. The Audit Commission tells us (October 2001) that "waiting times in A&E are increasing and are longest in London in larger departments". Yes, comrades, increasing! A master of euphemism, the AC also declares that "most hospitals will find it challenging (sic) to provide life-saving drugs for heart attack victims in the target time". Challenging! But this appalling condition is no one minister’s, no one doctor’s, no one manager’s, no one health trust’s fault. It is the system’s fault, the NHS’s fault.

Health care in London, for example, is now being rationed in ways which recall the glory days of consumer service in Andropov’s Soviet Union: queues, more queues, more disciplining of queues. Accessing medical help in the state system these days is a bit like trying to get into a fashionable restaurant. You can ring your GP and book an appointment for, inevitably, three weeks time. Or you can go round to A&E and wait in "reception" for four hours in the dim hope of being seen. (In A&E in London, only thirty per cent of patients are seen by a doctor within the hour). But is an admission system that might make sense for those keen to dine in Quaglino (book-well-in-advance or turn-up-and-hope) really appropriate for the ordinary Londoner who is sick? We think not.

In all too literal spite of its efforts with the NHS, the Government is building within the electorate a constituency of the inevitably disappointed, as some of the most bitter complaints Tony Blair faced in the General Election campaign all too plainly showed. The Government simply cannot win. Just recently, Alan Milburn, introducing a new "star rating" league-table system to improve hospitals said :-

"As every patient knows, there is too much variation in performance between England’s hospitals. That is not primarily about money. It is about management and organisation".

Partly, this is a coded message to hospital administrations to bring down the often appallingly long waiting lists that continue to make the very phrase "National Health Service" a cruel irony in the tormented lives of many families. No one should be questioning the Government’s goodwill towards the NHS - because that is not the point. The real point is that while problems are indeed "not primarily about money"; they are not primarily about "management and organisation" either. Nor are they about patient involvement and Michelin Guides to good hospitals.

Any Government is going to be in a constant state of guerrilla war against the chaotic incursions of consumer demand for health-care. The electorate has shown its unwillingness, except at the margins, to pay more tax. The same electorate wants no waiting lists, no rationing of health-care - but rather the best possible and most immediate treatment for every illness, great and small. The state, financed by tax revenues, is by far the biggest single provider of health care services in the UK. The Government, meanwhile, is very gamely committed to much improved "delivery" of public services, including health-care. The electorate, again, thinks it has already paid for health services through taxes and is full of angry certainties about who should put problems right : the Government.

None of this, in principle or in practical effect, makes sense any more.

Bad service and bad feeling - delayed treatment, stressed doctors, angry A&E patients, bed-blocking, waiting lists, trolley deaths - are not accidental or anecdotal within the system. They are the very functioning of the system. We repeat that no-one should doubt this Government's massive goodwill towards the NHS. But the wider, sharper truth is that those who can afford to pay extra for health-care are not being invited to do so. There is nothing particularly socialist about this outcome. And what we will not yield in tax, we should be induced to pay in other ways.

It is now down to the Left to confront reality. A fully functioning health system that is the envy of the world cannot now be adequately financed through taxation alone. All of the different alternative models, including NHS charges, should now be actively considered. And we should stop being so ideologically snobby about insurance-based systems which do not hold "free-at-the-point-of-use" as permanently sacred. And any socialist who can afford it should now take it as his or her political duty to procure private health-care plans and, where possible, not use the NHS.

Within the span of each generation, the total volume of household income in Britain is doubling. Because of the way we run the system, the perversity is that not enough of this hugely increasing stock of money is being beckoned into health care. The days of a free-for-all, wait-for-your-turn, Labour's-finest-hour National Health Service must, in an abrupt and undoubtedly painful act of philosophical disengagement, be concluded. Down the years, we have all got a little too sentimental over Bevan's Baby. Time for the cooing to stop.




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