Tuesday, May 27, 2014

Reflections on the NHS... and why we might be our own worst enemies

Yesterday, I blogged about my recent minor surgical procedure, noting how well everything went, how kind and caring the nurses were, how efficient the surgeon was. And it got me to thinking about the NHS, not something that I've had much cause to do in the past. You see, as a very infrequent user of the healthcare system - I've been pretty fortunate to remain in good health - it is the sort of thing you take for granted. It will always be there, it will be free (well, freeish), and it will cure you if you're ill, and save you when you get broken.

Its status as a national institution is such that it was showcased in the opening ceremony of the London Olympics, and was protected from cuts by the incoming government - David Cameron promised that, you will recall.

SInce then, the NHS has come under pressure. Yes, the budget has been ring-fenced, and has kept pace with inflation. However, funding a national hearth care system is more complex than simply ensuring that it has the same amount of money in real terms. Inflation in the healthcare sector is traditionally higher that it is generally, and you can't manage demand in the same way that you might otherwise. And, as we find new and exciting ways of prolonging life, whilst more and more of us adopt lifestyles that make us more vulnerable to illness, injury and disease, the demands upon the system change.

You can deal with that in a number of ways, I guess. You can simply increase the funding available, you can charge for some services, you can seek organisational savings or you can just axe some services altogether. You might attempt a combination of some or all of these. But, the problem is that if you raise taxes, the opposition attack you. If you charge for services, or reorganise, or axe services, likewise. And, if you're a politician, you might conclude that it's all too difficult and give up.

Unfortunately, like any successful organisation, the NHS has to change to face the changing circumstances as they emerge. How many expensive pieces of kit can you have, and where do you put them, how do you incentivise your staff to be more efficient whilst maintaining service coverage, how do you address the demands of local residents, who have differing priorities in different parts of the country? All of these things require thought and the ability to adapt, and yet we protest about change, condemning it as meaning the end of the NHS as we know it when we know that, after every supposedly radical (and widely opposed) change in the past, it has still been there, still dispensing healthcare to all at a cost far lower to the public purse than it does in places like the United States.

But, if we continue to have opposition parties blindly oppose change whilst not engaging with the creation of a vision for the future of such a critical public service, we risk preventing changes that could save the NHS for decades to come. Instead, we need political parties and campaign groups to come together to create a shared view of what we need as a country, rather than treating the whole thing as a football to be kicked from one end to the other whilst the rest of us look on.

We will probably need to be pretty creative about the future shape of the NHS, we may even have to make some compromises in order to secure the broad principle of free at the point of access healthcare, but with an aging, increasingly unfit population, we're going to have to do something...

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