David Mitchell column
Why spend a fortune on hospitals for people to die in when they could as easily get run over by buses?
“In the UK, we are spending £97bn of public money on treating disease and only £8bn preventing it,” the health secretary Matt Hancock said last week. “You don’t have to be an economist to see those numbers don’t stack up.” But Matt Hancock actually is an economist, so how does he know? I suppose he might have canvassed the views of some non-economists, but I’m sceptical about how rigorous that survey can have been.
“Hi Chris, Linda…” (good to get a gender balance) “… have you got a second?” Hancock may have asked his aides. “Of course, minister.” “You did classics and history respectively, right?” “That’s right.” (Chris is doing all the talking – come on, Linda!) “Great, so we’re spending £97bn on treating disease and only £8bn preventing it. Can you see that those numbers don’t stack up?” “Oh yes, absolutely,” says Chris. “Yes indeed, minister,” adds Linda.
It is possible that on such flimsy evidence rests the secretary of state’s claim that “you don’t have to be an economist to see those numbers don’t stack up”. And obviously they do stack up. As in, you could stack them up – you could add them together. They probably are stacked up in various summaries of government spending: stacked up under the heading “Health”. You don’t have to be an economist to see that if you stacked them up, that would make £105bn.
I don’t think he means that, though. I think maybe he means that £97bn is much more than £8bn. His point may simply be that you don’t have to be an economist to see that 97 is a larger number than eight. If so, I heartily agree and my only quibble is why, even with Britain’s rising life expectancy, for which Matt Hancock is doubtless keen to take credit, he considered that assertion worth the time it took to express.
To be fair, I think what he’s getting at is that, if we spent more than £8bn on preventing illness, maybe we wouldn’t need to spend as much as £97bn treating it. Unfortunately, though, you don’t have to be an economist to know whether that contention stacks up. In fact, you have to be something else. You need a completely different type of expertise.
And, in an ideal world you’d want every extra pound spent on prevention to save more than a pound spent on treatment – otherwise you’re just swapping money about. Matt Hancock clearly reckons it would, and it seems plausible up to a point, but it’s not as obvious as knowing that 97 is more than eight and the naughty man is trying to make us think it is.
What I don’t believe, by the way, is that, if you spent £97bn on prevention, you’d hardly have to spend anything at all on treatment. And, even if that did happen, it would be a disaster because it would quickly become impossible to defend the £97bn. It would look like it was being frittered away on nothing. People hate spending a fortune on fire prevention unless they can see that lots of things are on fire.
This is a problem constantly faced by those who seek to justify counter-terrorism spending. If they foil all the plots, no one appreciates them. So they keep the alert level scary and bang on about how many plots they’re foiling. I’m sure they’re telling the truth (by which I mean: they may be telling the truth), but there’s no doubt that it’s failing to foil terrorist plots, rather than foiling them, that has the greatest government pursestring loosening effect.
This isn’t a problem for Matt Hancock because I don’t think justifying greater health spending is his primary aim. So what is his aim? The context for his remarks was the launch of a Department of Health “vision document” entitled Prevention Is Better Than Cure. No one could argue with that idea. But when politicians go around saying something with which no one could possibly disagree, there’s usually something with which millions absolutely would lurking beneath it. And so it proved.
“For too long, the NHS has seen itself essentially as the National Hospital Service,” he told the Today programme. He reckons that’s wrong because only “a fifth of the determinants of the length of your healthy lifespan are caused by what goes on in hospitals”. A fifth! And yet the hospitals cost so much! The majority of the country’s health budget is being lavished on institutions that affect a mere fifth of the… you know… the determinants of the healthy thing. That’s ridiculous! Why spend a fortune on hospitals for people to die in when they could just as easily get run over by buses? Why waste money on intensive care units when, for the same money, you could print a seemingly infinite number of leaflets warning about salt?
Not leaflets though! I’m such a Luddite! Hancock is talking about “predictive prevention”, which, according to the departmental document “will transform public health by harnessing digital technology and personal data”. Just as people get targeted marketing from Amazon or Facebook, this will be “targeted health advice – specifically designed for their demographic and their location”.
This is such a Tory idea. Let’s learn from the private sector! We can replace those pricey hospitals with algorithms! That way, a computer can precisely instruct people on how not to get ill – and the fact that there will hardly be any hospitals will be an added incentive!
By all means, let’s encourage healthy lifestyles. It also makes sense (a better idea in the document) to offer genetic analysis so patients can be warned about health risks specific to their DNA. But the commercial technique of exploiting personal data to target advertising is a trick and a government department shouldn’t aspire to trick people even if it thinks it’s for their own good.
The health education the state provides should be the objective scientific truth about the causes of illness. It should be widely accessible, but not marketed, nor expressed differently according to what type of citizen a computer reckons will read it. That approach would be as contemptuous of the public as a corporation is of its customers and another way by which inconvenient truths are transformed in people’s minds into fake news.