How do we heal our beloved NHS? Let’s not politely sidestep the illness of the patient or hold on to the belief that everything will be fine. No amount of grapes and flowers or tea and sympathy are going to put off our addressing the reality of the situation any longer. With politicians finally drawing their heads out of the sand to address this contentious issue it’s not going to be easy, but it appears the time has come to take a dose of reality if we are to maintain our most popular national service.
Since its birth on the 5th of July 1948, the National Health Service has been a beacon of compassion, a shining star of fairness and equality that has been the envy of the world, particularly to those not fortunate enough to enjoy the wonderful benefit of tax-funded, universal, free-at-point-of-delivery healthcare. A significant portion of the opening of the London 2012 Olympic Games was devoted to our health service, testament to the pride and love we have for it and its global renown, and it is a strong contender for the issue that provokes the most passionate debate from all viewpoints.
This makes it a political minefield. No government wants to cut the NHS budget for fear of the backlash such action provokes: to be seen as callous, out of touch and to play straight into the arms of the opposition. So historically, the life-support has been maintained, plasters applied, ring fences erected and the problem passed on, then back, for the next government to deal with. Yet, as with many other areas of life nowadays, the stark reality of this country’s financial position cannot be swept under the carpet any more. Combined with an ageing demographic, the situation is so grave that even in the run up to an election, political parties are openly debating drastic, unpopular-with-voters measures.
The NHS faces an immense funding gap with recent figures anticipating annual costs will rise from £95bn to £130bn by 2020. We have a growing and rapidly ageing population; a massive obesity problem and all the health troubles that accompany that; life-saving yet ever more expensive medical advancements; sadly, increasing numbers of cancer sufferers and progressively virulent, drug-resistant viruses and diseases. We live in a radically different world to the one in which the NHS was first envisaged by then health secretary Aneurin Bevan. At the same time, there’s less money available than we have grown accustomed to in the past.
Then, we have the issue of what should be provided by the NHS: cosmetic surgery, sex change operations, IVF? How many times is fair? Who for? Where do you draw the line? Who decides? We don’t have the answers to all these issues and I don’t envy those ultimately tasked with having to find them, but find them we must. This is a good point at which to bring the legal profession into the equation. The cost of medical negligence claims to the NHS was over £1bn in 2012 alone and is projected to rise to consume almost one fifth of its total annual budget in the near future. Some patients and relatives genuinely suffer through negligence or incompetence and do everyone a service by not tolerating poor care; others are motivated or encouraged to pursue a case for personal gain or by ambulance-chasing lawyers – around one quarter of last year’s settlement bill costs went on legal fees.
When we view the NHS, we cannot see it as standing alone. It sits within a tangled web of national and local government, social services and differing regional requirements. It is the NHS that has to rescue older citizens who are not provided for by local authorities due to budget restraints or mismanagement; also, there is no incentive for social services to keep elderly people out of costlier hospital care as it is funded from a different budget.
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Unlike budgets, politics and the NHS cannot be separated. Yet, rather than political parties grandstanding about who will increase NHS resources most, our current circumstances and trajectory have altered so radically the rules of the game have changed. What to do, though? The Coalition government is putting more out to tender to private firms in the interests of ‘competition’, something that has clearly not delivered the expected savings in the past. Indeed, Blair’s New Labour government introduced the costly Public Private Finance Initiatives (PPFI) that continue to drain considerably more from the public purse than the original costs of the builds. Such steps towards privatisation also undermine the cornerstone of the model of free care that underpins the NHS.
Labour is mulling over a 1% increase in NI contributions to immediately plug the NHS black hole and help finance it in the future, a move first introduced by Gordon Brown in 2002 to pay for the biggest ever increase in its funding. This proved surprisingly popular at the time, but with the cost of an ageing society by far the biggest drain on the health service, there is concern about younger, employed people having to pay the care costs of those already of pensionable age.
The fact of the matter remains that we have reached a tipping point. No one who relies upon the NHS wants to see it disappear. It is hard to imagine anyone with an ounce of compassion wishing it away either. So, just as the NHS has to move with the times, perhaps so do our demands and expectations. At present, the future holds an increasing demand and a shrinking budget. Last summer, Lord Filkin of the House of Lords committee on demographic change accused the government and all political parties of keeping the public in the dark in the run up to the election about the true cost an ageing population will have on welfare and health services and of being “willfully under-prepared” to face the challenge. This finally appears to be changing, however much we might not want to hear it.
On a more positive note, aside from radical funding restructuring, other ways are being proposed that can help the NHS to move with the changing times we live in. Many reports discuss the huge waste within different sections of the health service, and tackling these effectively would make massive savings. Britain’s leading doctor, Sir Bruce Keogh, also advocates a more-for-less attitude with quality being improved whilst savings are made.
The drive towards the Polyclinic local care model is actually one of the original concepts of the NHS, albeit under a different name. Treatment at home rather than in hospitals is being promoted more, which is far less costly and also helps reduce the spread of infection. Prevention is a key factor. We can ensure that we are not letting down today’s children by educating them to exercise from an early age and providing food stamps and free school meals so they are not hungry, malnourished and suffering from rickets, scurvy and the like; so they grow to have a fighting chance in life and are healthy adults in the future, not ones that are an added burden on the NHS.
We can take greater responsibility for own wellness. Granted, this is more difficult for those on lower budgets or with disabilities, but it is precisely these people who should be helped at this juncture, before expensive remedial care is required. There appears to be more of an emphasis on this emerging at the moment. However, it is a personal choice we all have to make, just as being realistic about the ability of an already over-stretched service being able to fund every new, increasingly costly medical advancement for everyone is something we have to consider for ourselves, however uncomfortable that realisation is.
I have never worked within the NHS, but I contribute to it through my taxes and enjoy its benefits. It is thanks to the NHS and other amazing emergency services that I am here today writing this article following a near-fatal car accident in my teens. We all rely on the NHS in some way and we all have a vested interest in maintaining this deserving organization. Politicians are beginning to be more honest about its current predicament; we could encourage them to find some cross-party unity so that long-term, sustainable policies can be implemented.
Ultimately, the NHS belongs to all of us and should be treated with the care and respect we expect from it, whatever individual failings and mistakes may occur within it. If we wish to continue to enjoy its privileges in something like their current form in this modern world, perhaps we can take greater care of it by being more proactive in the dialogue about its future and doing what we can to maintain our own wellbeing by leading healthy lifestyles and eating nutritious food, in moderation. To look objectively at the long-term survival of our medical treasure, but do so whilst maintaining our compassion and belief in dignity, comfort and the relief of pain.
When it comes to our health service, we need to collectively decide what we want, and can realistically expect, from it in the present day. Perhaps it’s idealistic, but if politicians and we as individuals can find some consensus and work together realistically and responsibly, we might not always get what we want from the NHS, but hopefully we’ll get what we need.
