Several times in the past few days I've found myself becoming protective and defensive about the National Health Service. It started with the predictions of crisis in the A&E departments. My emotional responses were intensified by listening to the Health Secretary, Jeremy Hunt, apologising for the cancellation of elective surgery for a whole month. The apology was itself an example of refusing to accept responsibility while seeming to care deeply about consequences for which he and the current Government are largely responsible. I know that previous Governments have contributed to the decline of funding and the growing crisis, but since 2010 the decline towards collapse has sharpened. The Prime Minister also climbed on the apology bandwagon, using the customer services apology approach whereby the inconvenience and indeed suffering of patients is a matter of regret, but not our fault. In other words the apology is being redefined as a defusing and diffusing device, used to give the appearance of empathy and support, but which never reaches those deeper levels at which decisions are made, policies changed and resources restored to adequate levels.
Now there is every reason for every one of us to be protective and defensive of our NHS. Amongst the strongest arguments for the NHS is the basis on which it was founded, the vision that gave impetus to its formation, the politics and humane principles that underlay its creation.
Aneurin Bevan envisaged nothing less than a revolution in social care and community responsiveness to illness, vulnerability, suffering and human equality. The idea of a universal health service free to each at the point of need was always going to be a major budget cost needing realistic funding policies and a commitment to paying that expense because the NHS is worth it, because the people it serves are valued.
And right there, is one of the primary pressure points 70 years on. The worth of people is increasingly being set against the cost of their care. The evidence for this is now pervasive, and I would say corrrosive of the central vision of a National Health Service. The commodification of health care, the introduction of multi levels of highly salaried management over several decades, the value for money mentality that cannot see that profit is not the goal, the bottom-line obsession as the driver to budget cutting, resource scarcity and salary erosion our nations; these and other policies and principles are at odds with the fundamental nature of the National Health Service.
This is all aggravated by the layers of competing departments throughout Government where the Health Service is one amongst many loud voices arguing for its priority status. That requires a Health Secretary who is committed to the health of the Health Service. In his recent 'apology' Jeremy Hunt reiterated his frequent claim to want to create the best Health Service in the world. Which raises the obvious question, asked ad nauseam by Health Service Staff across all levels of medical and ancillary care, why then cut the funding? Why contribute to the crisis?
The politics and economics of running a National Health Service cannot evade issues of cost, affordability and long term viability. But that was also the challenge in the late 1940's when a post-war impoverished Britain nevertheless launched a health service which they knew would be expensive, and would therefore require the commitment and the financial sacrifices of a population prepared to pay the necessary taxes for the extraordinary benefit of health security. I am not arguing, I don't know that anyone is, that the NHS should have unrestrained access to public funding. Of course there has to be a sense of realism, legitimate constraint, acknowledging that not everything can be afforded, accepting that advances in medical technology brings new therapeutic benefits that have to be weighed against other demands from within the Health Service.
So not everything is posssible, but we know that. But that's not the same as cancelling a month's operations because a crisis has been created, even manufactured, by economic policies and Government funding decisions that are ideologically driven. And all this in a culture where truth, facts and realities are besmirched and befogged by a rehearsed vagueneness of content in rhetoric redolent of concern, but empty of substance and possessed of an adamantine commitment to market principles in a Health Service that was always going to be non-profit, would always run at a loss, and was formed as a national co-operative of medical care funded by taxes, and valued as worth it. Because behind that vision is a view of human community in which each human being takes responsibility for the care of each other. That's worth paying for.
And yes, efficiency and best use of resources is an absolute requirement. And yes, there are other areas of human flourishing that also need funding from the finite resources of a population's wealth and taxes. And yes, it will always be possible to improve, become more efficient, make better choices, cut back on wasteful practices, manage resources more effectively and deploy those who work in the NHS in ways that exploits their gifts and skills well, but without exploiting them.
In the end, the National Health Service is a loss maker if the thing that matters most is money.
But the National Health Service is this country's most profitable organisation if people matter more than money.
It is absolutely value for money if health is a life good to be pursued, enabled and delivered whenever needed to whoever needs it.
It is a national treasure, an experiment in social compassion withour equal across the world.
It is a major contributor to the nation's wealth if that is measured in social security, community health, and life quality for our most vulnerable, and for all the rest of us who, at some time in life, will become amongst our most vulnerable, and therefore most grateful for an NHS that is there for us.
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