Why we must take politics out of healthcare
Ed Miliband revealed that he wants to “weaponise the NHS” because he thinks he can use it to win votes in May’s General Election. This is unworthy of a man who wants to be Prime Minister and will not solve the challenges we face in developing the health services we need for the future. Instead, we must take politics out of healthcare – as we took it out of fiscal policy when we made the Bank of England independent – and establish a Commission which develops a national health service fit for the 21st century.
The reality is that the current crisis in the NHS has been brewing for a long time. Our medical professionals have long warned about the ‘A&E crisis’ which is always exacerbated at this time of year and will get worse when the weather worsens. Our deadly combination of ageing infrastructure and ageing people has been developing for decades. Advances in medicines and technology mean that the way in which we treat and care for people has changed beyond recognition and our drugs bill has shot up. Just last week, for example, NHS England announced that it was restricting the availability of some cancer drugs because it couldn’t justify their cost.
The problems are practical and long term. Politics, with its emphasis on winning votes and short-term horizons, cannot solve them. “Weaponising” such an issue diminishes British politics and distracts us from what matters. It manufactures false disagreement at the cost of finding long term solutions to real-world challenges.
In fact, a remarkable degree of consensus exists between Conservative and Labour parties. Both are committed to our current system above any of the alternatives to be found in the world. Both agree that our health services should be free at the point of delivery and paid for by general taxation. Both have introduced private sector provision into the system and both regularly commit to increase spending. The Conservatives promised an extra £2 billion in last year’s Autumn Statement and Labour have promised about £4 billion extra. To put these sums in perspective, the NHS costs us around £2 billion every week and our national debt is over six hundred and fifty times that amount (and rising). The sums are vast, but the difference is well within the margin of error that accountants deem “acceptable”. And throwing more money at the problems simply papers over the need to take decisions.
Tackling the crisis depends on us as a nation confronting the fact that our post-war health service cannot meet soaring demand for modern healthcare. Our health service’s future depends on positive debate which creates solutions to the challenges of structuring and funding healthcare over the coming decades; not short-term fixes for political expediency – such as a ‘cancer drugs fund’ or guaranteeing access to a doctor within 48 hours regardless of whether or not a person needs to see one that quickly.
As a nation, we must insist on such a debate.
We must reconsider how we deliver acute care across the nation. Where we have consolidated such services (for example, stroke services in London), we save lives. We need fewer, better specialist hospitals and a national plan for where we put them. Hand-in-hand with this, we need more community hospitals and services to deliver the chronic care needed to deal with conditions like diabetes closer to home. Modern lifestyles are seeing these conditions rise and diabetes alone is on track to cost 25% of the NHS budget by 2025. And it is a statement of the obvious that we must integrate our health and social care systems as, for example, most elderly patients have complex needs which straddle the two areas. It is shameful that such plans do not already exist.
Beyond acute care, we have to open our minds to alternative ways of funding our healthcare. The astronomical costs of providing more and more people with an ever-growing (often expensive) range of new treatments and drugs cannot – and should not – be borne by the taxpayer alone.
Other countries offer a range of payment options we should test. Norway charges patients to see their GP and for routine tests. Germany has a compulsory social insurance scheme. France uses a means test. In Denmark patients are charged (at cost) for their drugs once a modest annual budget has been spent; only the terminally ill are excluded.
I believe that, if we are to protect that important and much valued principle of access to the very best healthcare at the time of clinical need, we should introduce more personal responsibility into how we fund our NHS. We all make choices in life and long may we be free to do so. What we eat, what we drink and how much we exercise are personal decisions. But many of these decisions can adversely affect our health. For example, consuming convenience foods which are high in fat and salt, leading sexually promiscuous private lives, drinking too much alcohol or using illicit drugs. And this often increases the cost of our healthcare. I believe that individuals who knowingly make unhealthy choices should meet at least part of this cost, either directly through charges, or indirectly through insurance.
“Weaponising” the NHS won’t deliver the 21st century healthcare we need. We need a truly national, cross-party approach because the challenges will outlast any single Government. An expert and cross-party Royal Commission is needed to drive a national debate towards solutions. Within such a debate, I would leap to defend Conservative solutions: ones based on the vital values of personal responsibility, freedom and justice. But none of us is well-served by the current frenzy of political point-scoring. Let’s take away this political target and get on with building a service that delivers the best possible healthcare.
(An abridged version of this article was published in the Sunday Express, 8th February 2015)