THE next General Election will not be won on the issue of
health. Prominence will be given to the economy (correctly),
welfare (ideally), immigration (regrettably), and personality
(disastrously). On the other hand, it will not be won by a party
that neglects health, as the recent party conferences demonstrated.
From next May, the NHS can look forward to seven-days-a-week GP
cover (Conservatives), shorter waiting times for mental-health
treatment (Lib Dems), an extra £2.5 billion to spend (Labour), or
no HIV patients from overseas (UKIP). This liberality does not
extend to jam today, however: nurses, midwives, and other health
workers spent a wet Monday on the streets, protesting against the
Health Secretary's rejection of a pay rise for them. Despite the
recent reorganisation, costing an estimated £3 billion, an
estimated £5 billion is wasted each year. Poor hygiene and neglect,
says the Chief Inspector of Hospitals, might be costing an
additional £2.5 billion a year.
Given the size of the NHS, it might be best to think of it as a
small country, inhabited by 709,333 workers at the last count, with
a GDP of £113 billion (the 2013-14 budget). It operates a tourist
industry, except that, unusually, the visitors are happiest when
they stay the least amount of time. It was once run on Marxist
lines - from each according to his ability, to each according to
his need - and, were National Insurance contributions still the
chief source of funding for the NHS, it would be only about £8
billion short. (The link was broken many years ago.)
There are two concerns, however. The first, inefficiency, has
been touched on. The second is the inexorable growth of the need,
fuelled, as our health features this week point out, by obesity and
longevity. People are longer-lived and more sickly, prompting
renewed attempts to change the basis of the Health Service from a
Marxist to a mixed to a capitalist economy, beginning with
prescription and dental charges, and ending, we now hear, with the
suggestion that people pay for stays in hospital.
Free health care at point of need is not a right conjured out of
thin air. It is the fruit of an efficient, visionary, and, by and
large, popular system of taxation. The increasing involvement of
private enterprise is a perversion of this vision; but the National
Health project is being pushed in this direction by the burden of
expectation, as vast resources are used up attempting to repair the
damage caused by poor diet and drinking to excess, not to mention
the minority who persist in smoking. Better organisation and a more
motivated workforce are essential, but so, too, are new means to
tackle the poor lifestyles that are dragging the NHS down.