Want to save NHS? Then pick a service to cut
Which Cinderella service must be run down so another can be built up?
When Margaret Thatcher was aiming for high office, she was singularly astute. Although she was a research chemist and a barrister, it was always to her role as “housewife” that she turned when she wanted to woo the British public.
“Any woman who understands the problems of running a home will be nearer to understanding the problems of running a country,” she said in 1979, the year she was elected.
More than a decade later, in 1992, Bill Clinton observed, “It’s the economy, stupid?” to explain what voters really cared about.
Then, in 1997, Gordon Brown took over as Chancellor of the Exchequer and prudence held sway. Until she didn’t. Recession hit, Labour suffered severe losses, and as it exited in 2010, replaced by the coalition, Liam Byrne, chief secretary to the Treasury under Brown’s premiership, left a note for his successor that read: “I’m afraid there is no money.”
The new government gleefully gained great political capital from this unbelievably crass statement. Byrne later apologised. But I felt he was wrongly pilloried because he simply told it like it was. And how often do politicians do that?
The dangers of ordinary citizens speaking truth to power have often been pointed out – but just how much more perilous for power to speak truth to ordinary citizens? Let’s take our poor, beleaguered NHS as a case in point.
This week, we learned that testing all women over 30 for cancer-carrying genes would save 12,000 lives a year. Every year. Like every other voter, I immediately cried that we must invest the funding as soon as possible.
But then a few weeks ago, when other stories broke, I found myself calling for better care for women giving birth, an end to acutely ill patients languishing – and, in some cases, dying – on trolleys in corridors outside A&E.
By yesterday afternoon, I was yelling for improved funding for the benighted Welsh NHS, which is in a truly parlous state. But Cardiff says that it’s down to Westminster to loosen the purse strings.
But which Cinderella service must be run down so another can be built up? Who is prepared to publicly announce why Peter is being robbed to pay Paul? And explain why Elspeth and Ruairi can’t even get a look in?
Government is about many things, and a great deal of them are often too boring to get your head around. The NHS, however, we understand. Or at least we’re willing to understand if our leaders would only bin the ideological cant and be more upfront about the extent of the problems we face.
Recently, I called for the unceremonious sacking of Health Secretary Jeremy Hunt on the grounds he was presiding over failure. What the PM actually did was far more clever – or, should I say, devious.
For too long, Hunt has bleated on that failings in social care, leading to the horribly pejorative term “bedblocking”, have tied his hands in the NHS. Not any more, Jezza. By appointing you Secretary of State for Health and Social Care, Mrs May has handed you the ultimate poisoned chalice by making you officially responsible for both areas.
Good luck with that. I mean it, too; I’d rather have a properly functioning health service even if it did mean you took the credit. But first we need a grown-up conversation about what, exactly, the voters of this country want from their NHS, because resources are finite and we can’t afford to cover everything for everybody.
Should we channel funds into preventive care that stops people getting ill, such as tackling obesity, or should the health service’s primary concern be to treat the sick and injured? Are we willing to pay a penny or two extra on tax to safeguard our care, our children’s care, our parents’ care? These are philosophical questions that require thought and demand greater information.
Like many patients, I have received both exemplary care and appalling neglect. That seems to be the norm and when it comes to forming opinions; all that we have to go by is our personal experience.
There are lots of statistics on the NHS Confederation website, if you’re interested, such as NHS net expenditure (resource plus capital, minus depreciation) has increased from £78.9billion in 2006-07 to £120.5billion in 2016-17.
Planned expenditure for 2017-18 is £123.8 billion and for 2018-19 is £126.3billion. I have no concept whatsoever as to what that means except that everybody who knows about these things is adamant it’s not nearly enough.
I can sort of grasp that the NHS is the biggest employer in Europe with more than 1.3million employees and that it deals with more than a million patients every 36 hours. But I still have no context in which to place it.
That’s not my fault. Our would-be elected members trip over themselves to inform us about everything, whether we wish to know or not. Once they’ve got the ministerial job, they go strangely, unforgivably silent.
It brings to mind another of Baroness Thatcher’s most acerbic bons mots: “When I’m out of politics, I’m going to run a business. It’ll be called ‘Rent-a-spine’.”
I nominate Jeremy Hunt for the first transplant, before it’s too late for all of us.