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Paul Vallely: The NHS — from service to business 

15 June 2018

As it approaches 70, it needs money, not a market, says Paul Vallely


FAMILY tradition has it that my grandfather, a staunch trade unionist, was a leading light in a penny-a-week health scheme run by ironworkers in Middlesbrough. It gave free health care to their families in the days when a visit from the doctor cost half a week’s wages. The scheme, my grandma proudly once told me, was the precursor to the National Health Service.

The NHS celebrates its 70th birthday next month. Amid the unrelenting diet of media stories about how our health service is constantly on the brink of crisis, it is salutary to remember that pre-1948 crises were utterly routine for ordinary people. There was something noble at the heart of Aneurin Bevan’s idea that cradle-to-grave health care should be free for everyone in need. Even today, the NHS is said by the respected international think tank the Commonwealth Fund to be the best health service in the developed world.

Sadly, what began as a service has, over the past three decades, come to be seen as a business. Margaret Thatcher’s ideological conviction that the private sector was inevitably more efficient introduced to the NHS an “internal market”, creating an artificial divide between purchasers and providers. New Labour opened the door to further commercialisation, with dubious innovations such as Private Finance Initiatives, which loaded debt on to the service. Creeping privatisation continued under the Conservative-Liberal coalition, and sneaks on apace under a minority Conservative Government today.

Now, some 853 independent organisations contribute to NHS care — contracted by more than 400 local authorities and 209 clinical commissioning groups. The result is administrative chaos, with a costly superfluity of managers and consultants. To that mess has been added Tory austerity. Between 1948 and 2010, the NHS budget rose, on average, four per cent above inflation. Austerity has limited that to 1.2 per cent, even though inflation is higher in medicine than elsewhere.

All this comes at a time when the population is ageing, and demand for health care is consequently rising. In 1948, life expectancy for men was 66, and for women 71. Today, it is 79 and 83 respectively. Yet, of our national income, we spend only half what the United States spends — and significantly less than our European neighbours. According to the OECD, the rich nations’ club, Britain comes 24th out of 34 member nations in terms of the numbers of doctors per capita.

Opinion polls consistently show that the public is willing to spend more on health. The last British Social Attitudes survey showed that 61 per cent of us are ready to pay more tax for the NHS, compared with just 49 per cent in 2006, and 41 per cent in 2014. For the first time, more than half of Conservative voters back increased taxes for health.

Theresa May has hinted that she will give the NHS a birthday present of more funding to meet the needs of the ageing population. The word is that the Prime Minister has earmarked an extra £5 billion for the job. Sadly, the Nuffield Trust estimates that an extra £25 billion is what is needed.

There are several reasons not to vote for Jeremy Corbyn at a future election. But the current state of the NHS is not one of them. Health care is not unaffordable: the problem is simply a bad political choice by our present leaders.

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