‘Let us face facts. The NHS is no longer entirely free at the point of delivery.’
Bernard Ingham
ONE OF today’s paradoxes is that almost everyone agrees that our 70-year-old National Health Service is a good thing in spite of its recurrent crises. The present scandal over its failure to call thousands of women for breast cancer screening is the latest example of its deficiencies.
Yet I remain an admirer of the system. Indeed, you could argue that I am one of its successes because it has got me to 85 after a terrible childhood and youth caused by eczema, allergic asthma and hayfever, not to mention double pneumonia four years ago.
The steady advance in life expectancy, bringing the prospect of a whole regiment of centenarians, is another example of its general contribution to the nation’s wellbeing.
But the time is long overdue for recognising that the NHS cannot continue as it is with inevitably limited money, an ageing population, exponential developments in medical science and treatment and a failure to integrate health and social care.
It also suffers from the weakening of the concept of public service throughout society. We should not assume that every NHS employee, and still less staff in care homes, is driven by a determination to serve the public weal. If they were, we would have fewer complaints about difficulties getting consultation appointments, waiting lists and postponed treatments.
Gordon Brown’s ridiculous settlement with GPs of better terms and conditions for less work has caused more problems than it solved.
The NHS’s status as a sacred cow is also a handicap. It inhibits creative thinking just as Labour leader Jeremy Corbyn’s readiness to throw our money at it without regard to its efficiency eliminates any thought of reform.
I sometimes doubt whether Corbyn has a mind – let alone an analytical one – since he seems to be programmed to spout only hard-left dogma. So what should we do about the NHS? Well, before we even think about moving the chess pieces, we need to examine our attitudes towards it.
What is it there for? How, no holds barred, can that be achieved? And what needs to be done to facilitate its development into a justifiable cause for pride and joy?
Let us face facts. The NHS is no longer entirely free at the point of delivery. Just look at dentistry, prescriptions and the increasing practice of withdrawing some drugs from availability on the NHS as well as cataract operations and knee and hip replacements in, for example, Shropshire where my brother and his wife have had to pay for treatment.
We need a rigorous and open review of how modest charging, with due protection for the worst off, could transform delivery. Drunks, druggies and those who break appointments should be penalised for their abuse of the system.
We must abandon the idea that the private sector has no place in the NHS, provided we can make sure that it does not make a killing at the expense of the public purse. The proviso is important because, as NHS executives repeatedly show, they are past masters at paying over the odds for supplies because they do not use their collective buying power.
The besetting sin of the public sector is to spend other people’s money freely because it is not its own. It was not always so and it should not remain so.
In short, we need a revolution in public and NHS staff attitudes.
I suspect that the machine is too big and hopelessly bureaucratic. It needs breaking down into manageable local units charged with securing integration of health and social care, coordinated by compact regional monitors under a slim national hierarchy specifically charged with securing the efficient treatment of the entire nation, not just in particular postcodes, at the lowest possible cost.
The hold of bureaucrats on the system must be broken, with their propensity for rewarding themselves handsomely regardless of performance.
It is certainly time for the medical profession to examine whether we need a 10-year long apprenticeship of doctors. There is some evidence that the length of this training and young doctors’ exploitation in hospitals is driving them out of the profession or abroad at a time when we need every loyal and competent NHS servant on deck.
I am not daft enough to suppose that any new system would utterly transform the NHS, certainly not without a change in attitudes, because of the fallibility of human beings. But, given the will, we can surely reform it to improve its service to the public. Indeed, we have got to do so.
We need a rigorous and open review of how modest charging, with due protection for the worst off, could transform delivery.