National or Nationalised? Our 1940s retro health service.
Man the barricades, make up the placards, light the vigil candles, wind up the hyperbole … someone – Evil Tories, natch – are trying to tweak the NHS. This cannot be allowed to happen, of course, because the NHS is the Envy Of The World. We Love The NHS, don’t we? Without it, people would lie dying in the gutter while big businessmen in their limos swerve towards them to try and finish them off. Like in the USA, you know.
Yes, here we are again. The NHS is being ‘dismantled’ and the world will stop turning, apparently, because the bureaucratic PCTs – installed by Labour to put yet another layer of overpaid management between the patient and their treatment – are being abolished. The
woefully underpaid GPs will join forces to commission services themselves, and other changes are afoot which prove that while the memo on localism may not have reached the Department for Education, Andrew Lansley at Health clearly has read it. (This coming years after the Community Health Councils were scrapped by Labour in one of their typical outbreaks of government-knows-best control freakery.)
The health unions, naturally, are quick to claim that patients are at risk because of the changes. Just as the rail unions claim that passengers are at risk whenever someone suggests changing the timing of signalmen’s tea breaks, or future generations’ education is being wrecked because teacher’s pensions are being downgraded from gold- to silver-plated.
Of course, the patient ‘experience’ is unlikely to be significantly affected by the reforms – at least in a negative way. Even so, people are too ready to believe that it will, because it puts us further on the path to fundamentally changing the NHS as we know it – but that is a good thing, because the NHS is not fit for purpose and is financially unsustainable.
The trouble is that debates on the NHS often revolve around who is best placed to take the controls of the steam engine, each proposing their own scheme for shovelling ever more coal into the insatiable machine; all the while kidding themselves that to do so will somehow magically transform the old smoker into a bullet train.
When the Left tell people the NHS is under threat, they don’t mean the National Health Service, they’re referring to the Nationalised Health Service; the top to bottom state-run monolith, designed by 1940s socialists and fundamentally little changed since.
When the ‘p’ word is mentioned – privatisation – then what people hear is the crude and inaccurate stereotype of the US system, where they will have nowhere to turn to if they fall ill, unless they can afford it.
This caricature would be laughable if it didn’t cause such distress and stand in the way of reforming a system which in its present form costs too much money and, quite possibly, lives. Ironically the description is closer to the present situation than most on the Left would want to admit, for to do so would expose the truth that the current set-up is failing, and that the two-tier service that is so often warned of was created with the birth of the NHS. If you want decent healthcare, you are faced with a choice of the lottery of the NHS with its waiting lists, and waiting lists for waiting lists, or paying to go private – the latter effectively meaning you are paying twice for the treatment.
The problem with privatisation is that it has become a devalued term, used to describe any involvement of the private sector, including the off-balance sheet financing scams so enthusiastically embraced by Labour and which are now a major factor in the financial problems the NHS faces (and nothing to do with the austerity measures, evil bankers, tax dodgers, etc., etc. ad nauseum). Privatisation should be about taking politicians and civil servants out of the process, not just some perverse financial smoke and mirrors trick played by an economically myopic government.
So if any significant – and necessary – fundamental reform of the NHS is to take place, the public must be ‘de-indoctrinated’.
How to do it? We must go back to basics. When people say they love the NHS, they are not professing an undying affection for the bureaucracy. Stories of how loved ones have had their lives saved by the NHS are not testimonies to the fact that they were treated in a government-owned building, by staff with the letters “NHS” on their salary payslips. What they are showing is respect and thanks to the staff and their dedication and training.
Similarly, when ordinary people defend the NHS, it is not that 1940’s throwback that they value; the principle of decent healthcare provided free at the point of delivery is what people want to maintain. That is not a health service – it is health insurance. Test most people’s real understanding, and they would probably not care if the hospital in which their life is saved is owned and run by the government, a charity, a commercial operator, or Martians, as long as that care is provided and is covered by their (state) insurance. Put aside politically opportunist – or ignorant – misconceptions about ‘profit’ in public health and it is clear that it’s not a National Health Service that we really want or need, it’s National Health Insurance. (And yes, once that is established, one could extend the principle of choice to allow patients to opt-out and insure themselves privately – but that is another debate.)
Seperate the two elements of the present NHS, and you can then begin to have a rational debate on how to improve the nation’s healthcare.