Whither the NHS?

Or should that be "withers the NHS"? It's certainly not what it was, as evidenced by masses of anecdotal evidence and my own personal experience, the latter from both the point of view of a patient and as someone who has had an involvement at various levels in the management side. The received wisdom is that the British public has a deep affection for the NHS and regards it as the best health care set-up in the world which means that large numbers of votes are at stake for the politicians. But despite this, they can't resist tinkering around with it, believing this to be better (for them) than any wholesale changes, especially in the way its services are paid for. 

Now I'm not an expert on health economics and there are loads of people out there who are and who will have a detailed knowledge of how they do health elsewhere in the developed world but I've come to the view that we have just got things wrong, very wrong and major incisions with the scalpel are required, rather than just a couple of aspirin.

The trouble is that this major surgery cannot be carried out by the present government as another bit of received wisdom has it that any changes made by Tories must be a "bad thing" while Labour changes must be a "good thing", the Tories being inherently anti-NHS while the Labour party love it so much they would sell their daughters into slavery before doing anything to harm good old auntie NHS. This received wisdom is as misguided as the other bit above but, like the idea that Skodas are rubbish cars, received wisdom, however wrong it is, takes a seismic effort to shift.

This leads us into the worst of all possible worlds, where the Tories try to do good things but take fright every time someone squeals and then dilute changes to homoeopathic levels of ineffectiveness, whilst causing the patient no end of stress (and cost) nonetheless. This is made all the worse now we're in coalition mode and they have to share their ward with that bunch of in-house squealers par excellence, the Libdems.

Despite their supposed loved-up relationship with the NHS, most people have no idea how it's organised, which means they have no idea what the implications are of the Tories plan to abolish Primary Care Trusts and Strategic Health Authorities. If they did, they might realise that most of the people who work for PCTs are simply going to end up working for the new Commissioning Consortia and that SHAs will largely metamorphose into another form of bureaucratic meddling. In which case their anger might be along the lines of the changes not going anywhere near far enough, rather than being damaging in their own right.

Most people will never have heard of Monitor, the organisation that regulates Foundation Trusts. The government wants all hospitals, etc., to become FTs which of course means that Monitor will regulate pretty much everything. This is slightly scary (or rather exciting, depending on your point of view) when you learn that Monitor is not run by the Department of Health but is accountable only to parliament. Which means it's not really accountable to anyone at all. It's almost certain that most MPs don't know this either. 

Similarly, most people have little idea of the current extent of private sector, or quasi private sector, involvement in the NHS, which means that the shock horror response to the notion of NHS privatisation is laughable. Finally in this (heavily abridged) list of what people don't understand, the Private Finance Initiatives, a piece of Gordon Brown off-balance sheet financing of which any investment banker would be proud, which has saddled many hospitals with decades of horribly expensive debts. Until very recently this debt did not figure anywhere in government borrowing figures (just like public sector pension liabilities, but that's another story.)

In the meantime, the NHS remains sickeningly burdened with managers and administrators and with doctors and nurses who, thanks to the largesse of "Agenda for Change" (another thing of which most NHS lovers are blissfully ignorant) are paid more to do less. If you wondered where all that extra money that was shovelled into the NHS went (and my goodness it was a lot), well there you go.

New treatments are constantly being invented, which is a good thing of course. But couple this to longer life expectancy, which means more time spent in one's twilight years requiring NHS care (not to mention exploding breast implants) and you can see that the limitless demand created by the "free at the point of delivery" notion is guaranteed to lead to unaffordability and that's before the exponential rise in the number of bureaucrats, Agenda for Change, PFIs, etc., etc.

What's to be done then? Like I said, I know little of how things work abroad but I hear wonderful things about the health care system in France, for instance. It seems to me inevitable that the UK system is going to need radical surgery sometime soon. But it won't be the Tories who do it. If we want someone to rip up the current system and give us something rather different, it won't be the evil NHS-destroying Tories, it'll be a future Labour government. If the Labour party can do away with something as totemic as their own Clause 4, then surely then can be equally savage with the untouchable "free at the point of delivery" NHS.