Posted on November 28, 2011 by Phillip Lee

On establishing the NHS, Nye Bevan predicted that, after an increase in health spending in the first few years, it would cost the taxpayer a diminishing amount as the population became healthier.

Sadly, the naivety of that statement has been shown many times over. NHS spending has risen inexorably under Labour and the Conservatives alike. The total annual budget has risen from £437 million in 1948 (roughly £9 billion in today’s money) to about £110 billion today.

During the debate over the coalition’s Health and Social Care Bill, many vested interests, from the Royal College of Nursing and the BMA to management consultancies and private providers, have given their opinions, and politicians of all colours have proffered “solutions” to the challenges that the NHS faces.

But interestingly to someone who is both a politician and a doctor, few have genuinely addressed the real challenge — that however necessary it is to make the service efficient and effective (and coalition policies can certainly achieve that), the longer-term survival of the NHS really depends on how we mange the increasing demand for state-funded healthcare. Indeed, we have little option other than to try and reduce it.

This rise in demand has many causes, but the increasing cost to the NHS is clearly not sustainable, particularly in the prevailing economic climate. Life expectancy in the past 60 years has climbed by about ten years and obesity levels have risen, leading to an inevitable increase in chronic disease. Some experts suggest that Type 2 diabetes alone will account for 25 per cent of the entire NHS budget by 2025. With these changes have come remarkable advances in medical technology, surgery and drug therapy. All are very welcome; but they have dramatically increased costs to the taxpayer.

There has also been a real shift in patient behaviour. In my surgery recently, an 87-year-old man, dressed in his best suit, apologised for “wasting my time” before saying that he had crushing chest pain. Shortly afterwards, a 21-year-old woman, in her pyjamas, complained of a six-hour history of sore throat. Such differences in the perception of suffering, respect for the service and what constitutes an appropriate complaint just cannot be ignored.

The NHS was established when most Britons had first-hand experience of war and all its horrors. Such a stoic population had profoundly different expectations of life and views about pain and suffering. But that tough generation is now fast departing this Earth, taking with it their gratitude for any kind of state healthcare. They are being replaced by people who emphasise rights over responsibilities, to whom patient choice matters, irrespective of the potential cost, and whose expectations of a pain-free existence are far from realistic. Dealing with such behavioural change will not be easy. The baby-boomer generation, who have had an easierlife than their parents, are now approaching an age when their healthcare demands will increase significantly. How will they respond to the pain of osteoarthritis and the debilitating effects of stroke? Not in the same way as their parents.

The acccepted political wisdom has long been that you touch the NHS at your peril. Consequently, healthcare policy has become a game of musical chairs for both parties. Keep singing the old tune of “free at the point of delivery, management efficiency savings” and hope that it doesn’t stop while you are in office. That is no longer realistic for those of us who want to be in government in the 2020s. Both parties urgently need policies that are credible in the long term, not exercises in fooling the public.

But be it a “co-payments system”, as advanced by a former Labour minister, a supplementary insurance scheme, as preferred on the Continent, or a so-called “fat tax”, whichever policy is adopted must reflect a determination to bear down on demand by moving some responsibility for healthcare away from the State and towards the individual. No amount of tweaking the system will address the pressures of rising demand in the coming decades.

We must be honest and decide what the NHS is for. What should it provide? Is a person’s health the State’s responsibility? Those of us who want to protect the principle of healthcare provision based upon clinical need must be straight with the voters. And to those who say: “Don’t touch the NHS”; I would answer that we no longer have a choice. If we shirk responsibility and let the system collapse under the weight of demand, the truly vulnerable will suffer. We must get real about this issue — and fast.

Dr Phillip Lee is the Conservative MP for Bracknell and a practising GP

(Published in The Times, Tuesday October 18, 2011)