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NHS in crisis

17 October 2014

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.

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