AT THE age of 70, it is natural to need a little more medical attention, a few more interventions. This applies to organisations as well as individuals, the National Health Service, founded in 1948, as well as its patients. Every tribute to this magnificent organisation has been tempered by concerns about its present and future performance. On Monday, the BBC’s Today programme focused on the reorganisation of hospital care in Dorset. Although the programme acknowledged the need for increased efficiency, it made little of the main trigger for the reforms: a £159-million annual funding hole caused by a growing and ageing population. The response — concentrating acute provision in fewer centres — is copied from elsewhere. It means that the health of many people in the UK now depends on traffic conditions. It is unwise to have a medical emergency at the weekend in the West Country, or during the rush hour in London and other large cities.
This might seem to be a peripheral point to make, but it is symptomatic of the NHS’s problems. For every difficulty that it creates for itself — the multiplication of bureaucracy, the neglect of nurses’ expertise, the unhealthy training regime for junior doctors, etc. — larger and less surmountable difficulties assail it from outside, such as unwise lifestyle choices by the people it cares for, the imposition of new organisational models, and cuts in local-government social-care provision. Its well-being, therefore, is intimately bound up with the health of the nation, the financial standing of the Government, and the inclination of the electorate to turn its expressed willingness to pay more tax for a better Health Service into votes for a party that pledges to demand it.
There is much to applaud the NHS for. No state enterprise is nearer the heart of the gospel. It has lifted the burden of ill-health from the shoulders of past and present generations. Before it, when medical treatment was needed, the desperate question was: “Can I afford it?” This is no longer the issue. But a variant is now being asked in surgeries and hospital departments: “Can you afford it?” It is a question that has long lain below the surface, disguised by lengthening waiting lists, inferior drug treatments, and postcode lotteries. When, outside an election season, a government is motivated to promise additional billions, it is clear that the answer must often be no. But the cost to the nation of ill-health must also be taken into account. There has been much talk of late about low productivity in the UK. How much of that is due to workers’ being laid off with poor health, or coping with the ill-health of others? In this light, investment in the NHS is a balancing act. The Government is right to praise the dedication and hard work of NHS staff; but, if it wants to honour them properly, it needs to fund it better — and carry the electorate with it when it does so.