The NHS is a victim of success

Published by The i paper (4th June, 2018)

Today Jeremy Hunt became the longest-serving health secretary since the creation of the National Health Service almost 70 years ago. There will be few cheers, given the unpopularity that accompanies Tory tenure in this post, yet this is a significant political landmark as he overtakes Norman Fowler. Hunt has survived six winters, one fight with junior doctors and an attempted ousting, emerging from Theresa May’s January reshuffle with a bigger role rather than the business brief she had envisaged.

Hunt is a minister with rare devotion to his job, despite headlines that have branded him Britain’s most disliked frontline politician. Before previous reshuffles, he wrote to Downing Street asking to stay in post. He sees his challenge as offering stability to besieged services while improving safety, reducing bureaucracy and enhancing care. He spent time helping in the field to fully understand problems and has visited more than 100 hospitals to discuss his thoughts with staff.

He was right to focus on patient safety, which was neglected by predecessors and led to a series of lethal scandals. Victims of medical failure, political incompetence and professional arrogance tend to be vulnerable patients such as the elderly and those with disabilities. Sadly, I have seen this with my own daughter. Yet the NHS still often treats complainants, transparency and whistleblowers with suspicion. And Hunt’s dismal response to a review last month of early deaths among people with learning disabilities has undermined his stance on care.

One aide told me Hunt’s background as a successful entrepreneur had made him an unusually positive and resilient minister. Certainly his tenacity has paid off politically. His name crops up in discussions on May’s successor, while safeguarding the ailing health service is seen as vital to the party’s future after the mendacious Vote Leave pledge of a £350m-a-week boost post-Brexit. This has emboldened Hunt to push for more cash and publicly condemn a ‘crazy’ funding system.

Yet as the NHS’s anniversary looms next month, Westminster needs to grapple with more profound questions than the current cabinet tussle over size of bung offered for its birthday. There is likely to be about a three per cent budget rise, more than wanted by the treasury and less than demanded by the health lobby. This meets the Brexit pledge, although not from mythical savings – but this extra cash is just sticking plaster politics that ducks the big issues.

The NHS has been in regular crisis since birth. It is victim of its own success, aided by scientific and technical advances. We are living longer and there has never been better time to fall sick. But pressures build daily as a result, with more old patients and people with complex conditions relying on a service created in another age to tackle industrial accidents, infectious diseases and infant mortality. Last year staff handled 2.9m more people going to accident and emergency than in 2010, seven million more diagnostic tests and 57,000 extra patients starting cancer treatment.

These are impressive statistics. Yet demand will continue to surge. To take one indicator, the number of people living with multiple chronic conditions is rising eight per cent each year. The fix proposed by the Institute for Fiscal Studies would cost £4,000 per paying household annually if funded only by income tax, which puts the problem in perspective. Voters least willing to back such a move are those aged 25 to 44, the age group most alarming the Tories after abandoning their party. And extra money pumped in previously has led to lower productivity and higher pay, most infamously under the botched New Labour deal for general practitioners.

Yes, the NHS needs much more money. It also needs stronger focus on spending and waste. Tim Briggs, an orthopaedic surgeon and national director of clinical quality and efficiency, pointed out that screws used in back operations vary in price from £32 to £600 and data on long-term efficacy for patient outcomes is ‘pretty poor.’ This is unsurprising: the NHS is so sluggish on technology that it is the world’s biggest buyer of fax machines. And it is not just about cash: Scotland has higher spending per patient but worse outcomes, not all down to diet and drink.

Labour’s response is risible. Shadow health secretary Jon Ashworth promotes a regressive vision of a world in which ‘privatisation is banished and we restore a universal public NHS.’ So are they going to nationalise cleaning and catering, end prescription charges, force GPs to become state employees and make spectacles free again? Will they also ban any drugs or equipment made by private firms? No, this is just pathetic populism scratching at society’s scabs.

The challenge confronting our country, like many others, is how to deliver affordable health care by harnessing the best private and public services. One sensible idea is to fund the NHS with a dedicated tax to focus debate on costs. We should also end the daft and artificial distinction between social care and health care; it is ridiculous that the state funds a person dying from brain cancer but not from dementia. This could be funded by slashing the absurdly overblown aid budget, which is largely frittered away, along with clamping down on corporate tax dodging and legalising cannabis.

Yet the best birthday present for the NHS would be a dose of honesty when discussing its future. For all its fine staff, the NHS has a dire record on treating many conditions compared with other developed nations. Politicians must move beyond blinkered worship of a floundering system and start raising serious solutions. Professionals need to shoulder personal responsibility, not just bleat about money. And voters must accept they cannot have low taxes, high spending and perfect public services. Otherwise it makes little difference who is sitting in the health hot seat.

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