Future of NHS is about more than money, warns May
THERESA MAY has warned that good healthcare “is about more than money” as she said the NHS must adapt to meet 21st-century challenges in a speech to mark the service’s 70th birthday.
Mrs May told nurses and doctors that the service was set up “to serve a very different country in a very different time”. The NHS, which was founded on July 5 1948, must adapt if it is to carry on providing first-rate care for another 70 years, Mrs May said.
She told NHS workers at a Downing Street reception: “Every day, you get up and go to work so the NHS can continue to do what it has done every day for 70 years – provide the British people with some of the best healthcare in the world. I want that to continue. But for that to happen we must recognise that the NHS conceived by the likes of Beveridge, Willink and Bevan was created to serve a very different country in a very different time.
“Today, thanks to the NHS, people are living longer – but that brings with it an increase in dementia and other conditions associated with old age. Childhood obesity risks burdening the next generation with a lifetime of ill health, and our understanding of mental health has progressed significantly – it can no longer be treated as somehow ‘less serious’ than physical ailments.”
Mrs May highlighted her commitment to give the NHS an extra £20billion a year, but said: “Important though that is, we all know that good healthcare is about more than money.” She said she had asked the NHS to draw up a 10-year plan “to make sure every penny of the new funding is well spent”. She added that genomics, artificial intelligence and other technology would have a profound effect on the future of healthcare.
July 5, 1948 was the third anniversary of Labour’s landslide post-war election victory. On this day, 70 years ago, the National Health Service was born to proud political parents who have never been able to acknowledge that there might be something not entirely perfect about their offspring. As the NHS grew into a voracious adult with an apparently insatiable appetite for taxpayers’ money, they shut their ears to any suggestions that might make it work better for all. They continue to do so.
This inviolability is unique to the NHS and was noticed by outsiders within a few years of its foundation. Writing in 1959, Harry Eckstein, a Harvard professor, suggested the health service was “accepted as an altogether natural feature of the British landscape, almost a part of the constitution”.
It is this talismanic quality that has made governments down the years terrified of reforming the NHS. Even so radical a reformer as Margaret Thatcher dared only to tinker with the structure, introducing an internal market and management reforms but retaining the overriding principle that public healthcare should be “free to all at the point of use”. This is, indeed, its most compelling attraction: people are no longer denied treatment because they cannot afford it, though that is also the case in countries where health outcomes are better than here.
Free, universal healthcare was first mooted by Beatrice Webb, the Fabian socialist, in 1909. Two years later, David Lloyd George introduced a health insurance scheme, financed by contributions from employees, employers and the Exchequer, but which covered only male workers earning less than £160 a year. Most working people remained dependent upon charity for hospital treatment; the better-off had to pay, but taxes were much lower.
The shortcomings of this system led policy formers to revisit Webb’s idea. In 1926, a Royal Commission called for a medical service “supported from the general public funds”. The wartime coalition government produced the first blueprint for the NHS, which Labour adopted when it came to power in 1945.
From the outset, the health service was the focus of political division. Aneurin Bevan, the first post-war health minister, described the Tories as “lower than vermin” for opposing Labour’s legislation. The service also went spectacularly over budget, as doctors began to tackle the accumulated backlog of untreated conditions.
There were hopes that, as the nation’s health improved, so demand for medical treatment would diminish. But the opposite has proved true. Increasing life expectancy means more people live to the age where they contract diseases that are expensive to treat.
It has become apparent over the decades that to preserve a universal service it is necessary to sacrifice some of the founding principles. But the run-up to today’s anniversary has been used not as an opportunity to seek a cross-party consensus for change that would ensure the health service’s survival for another 70 years but for misty-eyed sentimentalism about a world that has long gone.
The marches staged in its honour; the badges worn fatuously by MPS; the religious services – all serve to reinforce this sense of ideological untouchability. Labour cleaves to one of the few monopoly-based nationalised institutions that remains from the party’s post-war mythologised golden era.
Nowhere else in the world is the delivery of healthcare treated like a religious rite. Nowhere else in the world has adopted the socialised system the British have been gulled into believing is better than anything that exists beyond our shores. Theresa May has pledged another £20 billion a year as “a birthday present” yet even this considerable sum is less than it actually needs. However much it receives, the NHS fails to fulfil patients’ rising expectations.
It was designed to equalise access and minimise personal costs but not maximise performance. As a result, quality is sacrificed on the altar of equality. The UK performs worse than almost any other advanced country in the prevention of avoidable deaths and below average in the treatment of eight of the 12 most-common causes of premature demise. It has fewer doctors, nurses, hospital beds and scanners than other countries and spends a smaller proportion of national income on healthcare.
The NHS needs reform to help raise more money and to shift a culture that engenders waste and inefficiency. A mixed funding system with other sources of finance, equitably raised, would allow gaps to be filled. The NHS must remove the entrenched barriers to innovation so that it can adopt new ways of doing things more quickly. The rapid advances in robotics, artificial intelligence and smart apps will have a critical role to play in future health provision. The people who pay for it want a modern and comprehensive health service, not one rooted in the past and worshipped like an ancient god.
Even so radical a reformer as Margaret Thatcher dared only to tinker with the structure of the service