The prognosis for the NHS is grim if no one has the guts to deliver reform
THE NHS is a fine idea that no one has yet figured out how to pay for. The founding principle of universal health care ‘free at the point of use’ was revolutionary in 1948 but today it is taken for granted, even as growing pressures on the service make that ideal harder to deliver.
Aneurin Bevan aphorised that ‘the language of priorities is the religion of socialism’ but 70 years on, his NHS still hasn’t pinned down its priorities.
New figures put the annual bill for prescriptions in Scotland at £1.3billion, or £250 per head – an increase of 26 per cent in the past decade. Inflation takes some of the blame but, even so, that’s a tenth of the overall health budget.
This is the point of the NHS, you might counter. We get sick. We’re given medicine. We get better.
That’s right, up to a point, but we have come to lean too heavily on the GP’s prescription pad for drugs most of us could afford to buy down the chemist.
Paracetamol was handed out 2.5million times last year, aspirin two million. A 16pack of either will set you back 30p in the nation’s largest supermarket chain. Since 2011, the NHS has spent almost £58million doling out three billion paracetamol tablets north of the Border.
Resources
Even with Theresa May’s £2billion ‘birthday present’ to the Scottish NHS, budgets remain tight. Is funding the alleviation of the nation’s colds and headaches the canniest use of resources?
Down south, they don’t think so. Since June, GPs have been banned from prescribing over-the-counter medication for 35 everyday conditions such as mouth ulcers, athlete’s foot and indigestion.
Annual savings have been pencilled in at £100million. If that seems a lot for verruca cream and flu tablets it’s because, once pharmacy fees and GP payments are factored in, prescribing over-thecounter cures costs the NHS many times the price of the drug itself.
Pay attention, Scotland, for this is your future. The SNP, which introduced ‘free’ prescriptions in 2011, will not admit it but similar curbs are needed up here and eventually they will come. Without them, the annual pill bill will become unsustainable. For a while, it looked like we might get a grown-up debate on the wisdom of abolishing prescription charges and whether those who can afford to should pay for their medicines.
The Tories went into the 2016 Holyrood election pledging to reintroduce the fees but took fright barely a year later and announced their conversion to medicinal socialism during the General Election. That’s the problem with a ‘culture of free’: once people are told they’re entitled to something, they aren’t likely to vote for a party that tells them they’re not.
Mercifully, the Tories still have some backbone when it comes to health reform. Their call for 24-hour pharmacies is a case in point. Too many patients present at the GP surgery or A&E with ailments that could be remedied by a pharmacist authorised to prescribe drugs. The Tory plan would ease the strain on doctors and cut waiting times in emergency departments.
Even then, this is tinkering with the wing mirror of a car that has three flat tyres and an exhaust trailing along the ground. The challenge of saving the NHS, the one no mainstream party will face up to, requires bold thinking about what the health service does, how it does it, and how it is funded.
Thinking is suspect in political parties and thinking differently downright frowned upon. Playing it safe wins elections but it puts the future of the NHS in jeopardy.
When the health service was founded, it served 50million Britons. Today, there are 66million of us and demographers predict we will be the most populous nation in Europe, at 77million, by 2050. We are also becoming an older country. In 1953, one in ten of us was over 65; now, it’s closing in on one in five. True, few these days go down pits or lug around steel beams but we eat and drink too much, are more likely to visit A&E and are only beginning to grasp the scale of our mental health problem. Diseases that once killed millions have been eradicated but every new drug discovered and every innovation in technology puts additional strain on budgets.
We are an expensively unhealthy nation and the NHS is struggling to cope. Either we will have to raise taxes or we will have to accept the need for fundamental reform. We might begin by looking, as we are so often encouraged, to progressive, social democratic Norway.
It has a universal health care system too, but one funded in part by co-payments. Patients are charged every time they visit a GP, undergo an outpatient procedure at hospital, pick up a prescription, have X-rays taken or blood tests done. In a 2017 survey of European healthcare systems, Norway came fourth, the UK 15th.
Priorities
Who will be the politician brave enough to say any of this? Health Secretary Jeane Freeman seems an unlikely candidate. She is an interesting character with quite the political trajectory. She started out as a communist, became a socialist and is now a Nationalist. At least we know she’s open to changing her mind.
Freeman is a fixer and will do a better job of heading off crises than her predecessor. The NHS needs more than a fixer, though; it needs a reformer. The Tories are about the only party Freeman hasn’t been a member of but, when it comes to public sector reform, she is like every other senior politician in Scotland: a conservative.
Reflecting on Bevan’s language-ofpriorities speech, Michael Foot observed that ‘the noblest nostalgic sentiments of a movement born as a protest against injustice were recruited to make justified and tolerable the harsh, essential selfdenials of a Labour government’.
Now the need for harsh priorities is denied in service of sentimental nostalgia. That’s the glum irony of the NHS. Those who profess to love it most aren’t willing to do even the least to secure its future.