The answer is ‘nothing much actually’! Does that sound like pie in the sky? Am I burying my head in the sand? The NHS is both cost effective and highly efficient at delivering health care to those most in need of it. It is an exemplar! It delivers value for money. Aren’t we all in favour of efficiency and value for money? Why are we messing about with the NHS?
‘Free at the point of use’ does not mean people take GPs for granted, seeing their doctor more often than is strictly necessary. The more people are encouraged to go early to see a doctor even if they are not sure of the seriousness of their complaint the cheaper it is for the NHS to treat illnesses and the better for patients too! The last thing we want to do is to discourage people from seeing their GP whenever they have health concerns.
We quibble around the edges about this and that, but surely it is good that those in need of health care can get it without consideration of cost. I want anyone who might have an infectious disease to go straight to the doctor as soon as possible! I also don’t want anyone to suffer unnecessarily simply because they can’t afford to go to the doctor and get the care they need. Come on folks. This goes without saying doesn’t it! This is one of the greatest achievements of our beloved nation. Because we care about our fellow man and because many illnesses are infectious we are all much worse off if medical treatments start to be rationed more and more by price.
In addition, there is being risk averse: you never know when you might be the one with a serous illness, worried about money. Isn’t it a joy to think you will get the care you need regardless? In the US the rich get far too much health care, the poor get far too little, and the nation, on average, ends up spending much much more for a much worse outcome. Do we want to move to a health care service more like that? Surely the reasonable answer is a resounding ‘no’!
So what is the issue with the NHS? It seems to be an issue of class warfare! The Tories are waging an ideological battle to reduce the size of the state no matter what the resulting efficiency-loss may be! The Tories are waging war against the 99%! Let me tell the top 1% this. They think they will gain from a smaller state, they will not! More disease, more squalor, more social divisiveness, less investment in infrastructure is in nobody’s interest.
Too much inequality is a bad thing and not just because it damages growth. It is bad because it damages the cohesiveness of society. The centre cannot hold indefinitely. Do not push it past its tipping point! We will all suffer as a result, with the possible exception, of course, of those who plan to live out their lives in tax havens in the Caribbean. I think, in truth, we will all be dismayed if public services in the UK are decimated beyond recognition. We will rue the day we allowed that to happen.
The chancellor is looking for some good publicity to soften the pill of his mid term spending review. He has announced today, ahead of the spending review, that £3.8 billion of extra funding will be made available for the NHS in 2016/17 and a further £1.5 billion in 2017/18. This is not new money, it is ‘front-end loading’ of already promised money, suggesting that in subsequent years funding will be squeezed more sharply. What worries me even more than this is that Simon Stevens, NHS chief executive, says of the extra funds, “It will help stabilise current pressures on hospitals, GPs and mental health services and kickstart the NHS Five Year Forward View’s fundamental redesign of care.” What the hell is that? Did we vote on it? Do we want this ‘fundamental redesign of NHS care’?
We already know that the funding has been made available by raiding other parts of treasury spending, including bursaries for training nurses. Surely the chancellor is storing up problems in the future. We already spend far too much money on agency workers and we rely heavily on staff coming from overseas. Surely we should be making it more attractive not less attractive for people to train, qualify and then take on permanent employment in our NHS. Once again the government is doing the exact opposite of what the country needs. Cutbacks in community care are, similarly, a false economy. NHS beds become occupied by medically fit patients who cannot be discharged because local service care is inadequately provided for.
Is all this ‘financial discipline’ necessary because, as we are frequently told, we need a strong economy to finance public services and too much spending puts this at risk? We need to tackle this myth head on! Spending on investment in our community does not put the financial strength of the economy at risk. The truth is the exact opposite. Austerity damages growth. Inequality damages growth.
Government spending does not ‘crowd out’ private investment, it raises the return on private investment. Private investment relies on strong public expenditure, particularly on the provision of good public infrastructure. The two go hand in hand. Demand and confidence are improved by reflationary measures. Growth in revenues will provide the finance for the increase in government expenditure. This is known as the multiplier effect. If you want evidence of how the multiplier works in practice consider this: since 2009 the chancellor’s austerity programme has increased rather than decreased government borrowing. This is because of the downward multiplier effect. What we need is to get the multiplier effect going in the reverse direction in order to help get us out of the recession.
While management costs in the NHS have been falling in recent years the number of ‘super-managers’ earning around a quarter of a million pounds a year has soared. We have lost the highly effective middle managers, those who have a strong grasp on what the needs are at ward level. We have also, simultaneously lost the attractive career structure needed to retain good, permanent staff with the NHS service. We need to put all these revisions into reverse and to start appreciating the great public health care service that we have in this country. It is one of the greatest achievements of the twentieth century. We do not need an ‘ambitious plan to transform the NHS’. What we need is for our beloved NHS to be properly staffed and properly funded by our government.