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The NHS in Britain was formed in 1948 by a Labour Government with Clement Attlee as Prime Minister but the driver of this great institution as it was to become was the Welsh MP, Aneurin Bevan.
Prior to 1948 Britons had to pay for health services. So, if you could afford it you lived and if you couldn’t, your life expectancy was limited, particularly in slum filled cities still recovering from the effects of the First World War and the aftermath of Victorian Britain when the differences between the haves and the have nots was very marked indeed. These differences led in most part to the creation of the Trade Union movement ably supported by the Labour Party.
The founding of the NHS was only a part of a wholesale movement towards socialism in the UK with the creation of the Welfare State. After six long, frightening years of World War Two, Britons had had enough of living in fear and austerity and voted out of power Winston Churchill’s Conservatives in favour of Attlee’s Labour. Although rationing continued into the early 1950s, Britons saw the provision of free health, free glasses, free dentistry and some level of support if you were out of work as a step in the right direction.
The basic premise of the NHS was that it would be free at the point of delivery. The use of the word ‘free’ has always been exaggerated but Britons thought it to be true, casually overlooking the simple fact that it was not free but paid for through the nation’s taxes. By this Treasury slight of hand, all Governments since 1948 have managed to imbue a sense of governmental largesse as if a government is keeping the nation healthy by some sense of state sponsored altruism and kindness. Along with the other services of the burgeoning Welfare State in this country the founding ideas of these services being a safety net for Britons gave way to a mounting sense of entitlement and with that the ability of the political parties to use it as a bargaining chip with the electorate when it came to votes.
Having founded the NHS in particular, the Labour Party has managed to live on the splendour of its creation for the best part of 70 years and create an aura around it that forbids criticism. In other words, the NHS has become a national treasure much like some famous entertainer enjoying national love and veneration.
You criticise the NHS at your peril. You change General Practice and Hospital practice with the electoral risk of Armageddon for your party.
Aspects of the ‘free’ notion have been changed over the years and governments have got away with it. Prescriptions for medicines from your GP are no longer free and, in fact are relatively expensive, less and less dental practices give NHS service but people have insurance policies to cover the costs of work on your teeth. The same applies to ophthalmic services. Eye tests cost money, resultant glasses and lenses cost money. There are some exceptions to these charging services but the fact that most of us pay towards some or all of them has become generally accepted. Likewise, the NHS has opened itself up to private competition such that through insurance companies you can have access to private healthcare.
So, all of this works well and is wonderful isn’t it? The envy of the world. A social service copied by dozens of other countries around the world. Not quite.
Unfortunately Aneurin Bevan didn’t have a crystal ball and with only recent data to go on regarding the life expectancy of Britons which, as I said before, pre-1948 was not too good if you were poor, he couldn’t have foreseen that we might just manage to get healthier, eat better, keep fitter, clean up our environment (remember the smogs of the early 50s) and so confound all the insurers and forecasters and have the temerity to live longer. We are now having the gall to live into our 80s when in Bevan’s time you did well to live beyond your 60s. These gradual improvements in our health standards have produced gradual pressure on a health service designed to bury you at 70 not keep you alive at 80.
The word ‘crisis’ has now become the everyday word to describe the ability of the service to provide what we still regard as a free service.
In the time since 1948, the NHS has become one of the biggest employers of people in the world. More, I am reliably informed, than the vast Indian railway service. It has a labyrinthine management structure above the coal face workers of doctors, nurses, porters, caterers. This management structure is often augmented by a vast array of hugely expensive management consultants brought in to plan and implement the latest practice changes throughout this vast employment bubble. These changes, over the years have cost eye watering amounts of money and, by and large, have never proved successful, leading to abandonment part way through the implementation. Everyone then goes away into a huddle to try and cook up the next wheeze in the vain hope that it will be successful when all the evidence of the recent past points to quite the opposite. Whatever government party that tried the latest structural change is never called to account on this latest waste of public money and the project is allowed to wither on the vine as if it never happened. A recent example of that was the so called national connection of every health practitioner in the land to your health records regardless of where in the country you happened to become ill. The world is connected through the Internet and money can be transferred from one side of the world to the other in nanoseconds but somehow our management consultancy firms couldn’t make this system work and many, many billions of tax payer pounds later it was quietly shelved.
And yet the NHS is short of money and in a permanent state of crisis. Aneurin Bevan must be turning in his grave. As another writer for The Daily Globe, Sam Hooper, wrote recently on the NHS, we now figure at number 30 of 32 major nations of the world when it comes to survival outcomes in a significant array of health killers such as heart and lungs amongst others. Number 1 is Japan! Healthcare practitioner costs are fixed by the Japanese government but individuals then pay about 30% of the cost of the care through insurance policies. The current budget for the NHS is circa £135bn a year – free to us of course at the point of delivery, remember. Where do we think that free money comes from? If that is a free service, I’m glad it doesn’t cost us anything. Imagine if we were having to pay for it. But you can’t criticise our national treasure. You can’t propose alternative funding strategies. When the budget is exceeded which it is every year, you can’t demand accountability. God forbid the NHS managers with their clip boards, targets and time and motion studies might have to account for the money. We now have another ‘crisis’ of social care or patients who have the temerity to stay in their beds when they are well because they cannot be discharged because there is no family member who will stand up to the plate and care for them after discharge (remember our growing sense of entitlement- we have this service free don’t we so it is the NHS’ responsibility to look after post discharge patients). It has the apt name of bed blocking. The Labour Party leader, Jeremy Corbyn wants post discharge social care to be nationalised. No mention of where the money would come from but that is left wing socialism for you. I thought the NHS was already nationalised but maybe social care is something we as consumers of service might need to look at paying for.
So where do we go from here?
Let’s look at our way of life shall we?
If you are clinically or morbidly obese you don’t need to worry about contracting Type 2 diabetes and lose the odd leg or two because the NHS will care for you as you are entitled to that care aren’t you? You have no responsibility for the state of your health and yet, if you run a car, you have no concerns about taking it to your local garage and paying for it to be fixed if it goes wrong.
If you smoke heavily and drink likewise, it’s not your problem is it when you go into hospital with lung cancer or liver damage? You are entitled to be cared for aren’t you?
If you have a pet, a cat, dog, horse for example you love it and take care of it and provide private healthcare with the local vet through an insurance policy. Many people in the UK now have an insurance policy for dental care. We pay for our eye tests unless we are exempt and buy our new glasses when needed. You can’t get a mortgage on your house unless you take out buildings insurance and unless you are completely dumb you take out contents insurance in case of theft or loss. Running your car you have to insure it and pay a tax to put it on the road.
A bit flippant but forgive me – if you want to see your national treasure of an actress in a play, you have to pay to watch her. She doesn’t come free because she is a national treasure.
We are conditioned in most aspects of our lives to paying a fee or an insurance policy for something we either want or it is a condition of acceptance that we agree to. Whilst we may not do this too willingly, we do it because we have no choice.
Since 1948, no political party has ever been able to talk about alternative funding models for the NHS without committing electoral suicide. The consequence being that when Labour is in power, the Conservatives moan about how badly Labour is running ‘our NHS’ . When the Conservatives are in power, Labour does the same. The NHS has become the proverbial, political football. Amidst all of this we have our annual NHS crises, calls for still more funding, various Unions flexing their muscles at how appallingly their staff are treated, management spending more and more money on half baked efficiency schemes and no one taking any responsibility for budget overspending as the NHS seems to have become the one aspect of British life where there is no accountability to the people.
The UK spends less as a percentage of GDP of what is called the EU-14 on healthcare. If we were to bridge the gap between the UK and EU-14 by 20/21 we would have to increase the NHS budget by some 30% taking the budget to some £180+bn a year. The taxation required to fund that would be immense and the burden on working people to pay the contributions of those who no longer pay substantial levels of tax or National Insurance would be enormous. Those not paying taxes are by definition the old and the retired of whom there is an ever growing number as we are all living longer but calling on the NHS to provide medical care at an ever increasing level. It has become fundamentally apparent that the NHS management can’t manage the budgets it is already given so giving them even more money is a bit like giving a child in a sweet shop access to sweets and not expecting him to gorge on them.
If the reader cannot see that we have an ever more unaffordable healthcare system then I have obviously failed in my mission to provoke secondary thinking of alternative funding models for the NHS.
As I have said before, no one Government can put in its election manifesto that on General Election victory it intends to revamp, rethink and remodel the funding of the NHS.
It is therefore imperative that a group of MPs with the appropriate background, aided by academia, the consultancy sector and public finance experts, should come together and put forward a complete policy shift from the untrue proposition that the NHS provides a service, free at the point of delivery. It does not and never has done.
Such a cross Party group need to examine the funding models of dozens of countries in the world of their healthcare services, align the costs with the health outcomes to ensure value for money and then propose a cross Party agreed restructuring of healthcare funding.
As with most aspects of how we live and pay for our lives, I would suggest that this is going to have to be a balance of public and private provision paid for by a mixture of public taxation and enforced insurance as they do in Japan and probably every other country in the world.
It is time to take the politics out of healthcare, tell the truth about the real personal costs and for the nation to wake up to the fact that the NHS is not free at the point of delivery and that as a nation we cannot afford to keep thinking it is.
