The politics of the NHS

The fate of the NHS is a hot election topic, so I have updated my previous version of this post. There, I had pointed out that the NHS was not some sort of business that could be taken over or put up for sale. It is a lot more complicated as the NHS is not a single body. As the Kings Fund said at the time of the last major NHS reform in 2011,

The NHS has always involved a mixture of public and private provision. For example, most GPs are not public employees but rather independent contractors to the NHS. This was part of the settlement struck with GPs when the NHS was established in 1948. Dentistry is another profession that has remained largely outside the NHS while receiving NHS funding. In recent years, the NHS has become an even more mixed system, particularly in England. Reforms introduced by Labour saw private sector organisations becoming involved in new ways. Despite this increasingly complicated picture, the NHS today [2011] remains a public system, funded by public money, and delivered mainly by publicly owned providers. ISTCs, for example, perform just 2 per cent of all elective (planned) operations funded by the NHS.

America is certainly keen to open up the NHS to it’s drug companies but only if current restraints on pricing are scrapped. This could see the price to the NHS of many drugs soaring, draining their budget and no doubt leading to some form of rationing.

The NHS is funded mostly from general taxation, not national insurance contributions. To inject even more money into the NHS the Government have two options. Borrowing or increased taxation. Borrowing is fine for capital projects such as new hospitals and equipment, but can’t be applied to year-on-year costs such as salaries, running costs and drug costs. This has to come from government income i.e. taxes.

No Government is going to have the balls to tell the electorate that harsh truth as increasing taxes is a sure election looser! So promises are made and questions about how to pay for it met with waffle.

In any case, my own view is that all that is nibbling at the edges of the elephant in the room. Namely that the current NHS is far too big and ambitious. The problem is that successive Governments have played politics with health and allowed the public (electorate) to get used to ever more facilities available on the NHS. Many of these were never intended to be part of health cover when the NHS was first visualised. The Government meant it as a catch-all backstop to help the working classes who suffered the most from lack of health care at the time post war. The middle and upper classes were deemed OK as they mostly had their own private health provisions. The promise that the NHS wouldn’t therefore cost much was what swayed a wavering Government to approve the NHS. But fatally, they never made this clear, instead, making political mileage from the sweeping new changes which were misleadingly presented as a health service for all.

However within the first two years, it became clear that the middle classes had leapt on the NHS and already were swamping it. The Cabinet held hasty meetings and made the disastrous decision to put more money into the NHS rather than risk loosing votes by excluding sections of society. Successive governments have followed this course ever since, resulting in the monster NHS we have today.

I can not emphasise enough that this is the core problem in my opinion. But it is too late. Any suggestion of restricting the use of the NHS or of reducing the extraordinary wide range of treatments on offer would be political suicide. The Government is caught in a trap of its own making.


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