Despite the Conservative Party having promised to increase NHS spending by £8 billion a year during this parliament – the minimum demanded by its managers – we learn of a crisis within the institution that promises a financial shortfall of £20 billion by 2020-21. Without (so far) any consultation, the NHS proposes a massive reorganisation that could include hospital closures and cuts, and these could start within months, just as the NHS suffers its winter overload.
Why have things come to this? According to Government figures, the £437 million spent in the first year of the NHS’s existence in 1948-49 is equivalent to £15 billion today. Yet the UK total spent on the NHS is now £116.4 billion, £101.3 billion of which is spent in England. The population is nearly a third larger than in 1948-49; we are 64 million people against the 50 million at the 1951 census, thanks not least to the last Labour government’s mass immigration policies and the EU’s refusal to let us control our borders.
Yet this population growth cannot account for such an enormous real increase in spending. The problem is that the NHS is doing things its founders never envisaged.
It also suffers from grotesque overmanning in non-medical staff, a lack of strategic planning to cope with demographic change, and many of the failures associated with the absence of an effective price mechanism. Without rethinking its whole purpose and method of operation, it will, within a decade or two, simply collapse.
Even though this is no longer 1948 – our standard of living, our disposable income, our awareness of the dangers of smoking are all radically different from then – governments have avoided profound NHS reform for decades.
Labour wouldn’t touch it because of the mythology it has sedulously created: that the NHS, free at point of use and controlled on the shop floor by comrades in the trades unions, for whom it represents a considerable employment opportunity, is “safe” only in Labour’s hands.
“Safe” in this context equates to eating up a sixth of public spending without worrying too much about how and where that money is spent. The NHS now employs 1.5 million people. As its website proudly proclaims, only McDonalds, Walmart, the US Defence Department and the Chinese People’s Liberation Army have larger payrolls. It may not have occurred to the NHS that this is not necessarily something to be proud of.
The Tories haven’t addressed the NHS with serious radicalism because they fear reinforcing the Labour mythology: that any reduction in spending, irrespective of how it is found, must prove an underlying Tory hatred of the NHS and, therefore, of the people it serves.
This is utter nonsense, but nonsense that has so crippled the Tories that in one whole election campaign – 2001 – they tried not to mention the NHS at all. One hopes the Government has noted the near-death of the Labour Party, and the near-certainty that it will be at least another five years before Britain has a credible Opposition, and will now take reform of the NHS to a hitherto unimagined level.
We are in this mess not least because of the refusal by all governments over the past 30 years to think strategically. Lord Fowler, one of the best health ministers Britain has ever had, warned colleagues in the mid-Eighties that the growth in the ageing population would put impossible strains on the NHS.
Large amounts of beds and resources are devoted to elderly people in hospital because there is no place for them in a care home, and they can no longer manage at home. This is scandalous and, next to the dismal state of Britain’s defences, the present Government’s greatest dereliction.
The Health-Care Survivor’s Comment
The full text of this article, with its accompanying video, and figures, is much more political, in tone, than the articles I usually post. Sadly the provision of health care in the UK is often described as a ‘political football’, used to score party political points, making reasoned argument, and honest debate difficult to find.
This article could be seen as an example of ‘political football’, or an attempt to spark an essential discussion of the future of the National Health Service, if we want to protect it, and therefore ourselves, for the decades to come. Your view of this article will reflect your view of what it does, and what it should mean, to have a health service, free at the point of use.
As always, your comments are welcome.