John Marriott: It’s time to tackle the NHS crisis

I am sure that quite a lot of us can recall a serious brush we’ve had with what politicians are increasingly calling OUR NHS. I certainly can and cannot thank the health professionals enough at Lincoln County Hospital for the treatment I received just over two years ago. I and my family have in the past used private medicine as well, and my wife and I used ‘public’ medicine when living in Canada and Germany. Believe me, pound for pound, we get a fantastic deal out of our NHS, so, for goodness sake, let’s make sure it gets what it needs to continue to provide at least its current but ideally an even higher level of health care into the future.

When we get bombarded with facts and figures from all sides it is hard to work out which ones to believe. Many so called experts, and especially politicians, tend to use them rather like a drunkard might use a lamppost, namely for support rather than illumination.

All I know is that, as Joni Mitchell once famously sang; “…you don’t know what you’ve got ‘til it’s gone”

. We pay less of our GDP (Gross Domestic Product – for the uninitiated, the total value of goods and services produced in a country in one year) on health care than, for example, France or Germany and considerably less than the USA, albeit that the health care system in these countries is insurance based.

There are those who still advocate an insurance-based system over here. Indeed, that was the system favoured by the Tories when the NHS was founded by the Labour government after WW2. It took the 1956 Guillebaud Report, which Churchill’s post war government commissioned to look into the long term funding issues of the service and which found the system introduced by Labour to be the most cost effective, to get them to change their minds.

That report concluded: “The advance of medical science continually places new demands on the service and the standards expected by the public continue to rise”. How true that turned out to be.

I’m slightly older than the NHS, which this year celebrates its 70th birthday, so I don’t really know what things were like before, except by watching shows like Dr Findlay’s Case Book and reading the odd historical article.

Medical care was clearly a patchwork affair as we went through the first 45 years of the 20th century. Many practitioners gave some of their services free of charge, whilst earning their living from ‘private patients’. Charitable organisations often provided basic cover where the ability to pay did not exist or was limited. Medical cover for the majority was often the survival of the fittest.

All that changed after 1948; but persuading what has been and still is in many people’s opinion one of Britain’s most powerful Trades Unions, the British Medical Association (BMA) to play ball was almost beyond the capabilities of even the charismatic socialist Health Minister,

Aneurin Bevin. “I stuffed their mouths with gold” was how he described winning over Consultants, by allowing them to continue private practice in addition to their duties in the NHS. Many opponents even argued that, with free prescriptions, the ‘poor’ would simply empty pharmacists’ shelves. But that didn’t happen.

So, here we are 70 years later with another ‘winter crisis’ in our hospitals, and with both Labour and Tory politicians blaming each other for this.

I don’t think I am alone in wishing that all political parties would just get together and come up with a depoliticised plan to put things right instead of trying to score brownie points off each other.

I notice that the Lib Dems are currently proposing a “cross party health and social care convention” in addition to their well publicised 1p on the basic rate of Income Tax; but the chances of getting the bigger parties to sit down together are pretty slim, particularly while Labour thinks it’s got all the answers and, pardon the pun, momentum.

As regards who should be footing the bill for improvements, most people, when asked, say that they would be prepared to pay higher taxes for better health care. The proviso for many is often so long as it’s other people who are paying. That luxury may not, nor should be available any more.

When the NHS was founded, life expectancy was much lower than it is today. Most male adults were lucky to reach 70. The fact that final salary pension schemes are largely considered no longer sustainable actuarially should be setting alarm bells ringing. We are living longer and many of us are carrying chronic health conditions into old age.

Operations and procedures that would have been considered science fiction even a generation or so ago are now commonplace and many of them, including the latest wonder drugs, cost a lot of money. We probably do need a Royal Commission to come up with a long term plan; but that would take an age to be set up and to report. We obviously need action now.

Perhaps we need to transform National Insurance contributions into a Health Tax or perhaps we need a brand new tax ring fenced purely for Health and Social Care.

I’m not saying that money is the only answer just as I am not convinced that the NHS could not do things differently. Following the failure of the disastrous Lansley reforms we need a fresh direction of travel. Combining Social with Health Care is an obvious step in the right direction.

We also need greater emphasis on healthy living. When you are young you often think you are going to live forever; but those young and not so young people binge drinking in city centres at the weekend or downing a couple of bottles of plonk per night at home are storing up a load of problems for themselves and society in general sooner than they think.

Then there is the fairly sedentary lifestyle that many of us have, with obesity levels, especially amongst children, far too high. It’s back to ‘education, education, education’, as someone once famously said.

If we are going to put large extra sums of money into Health and Social Care, we should not be just expected to be trawling other countries in search of their home trained health and care professionals.

We need to train more of our own.

At least as far as doctors and nurses are concerned we should offer more bursaries on the condition that, once they qualify, they should be obliged to work for a specific time in the NHS in places where the greatest shortages are before considering working in the private sector or abroad. Failure to comply would mean that they would be legally required to pay back the money, our money, they had received.

Also, do you always have to have a degree to nurse? I’m not knocking qualifications, but surely empathy is equally important.  If not enough potential nurses come forward, perhaps we need to follow Bevan’s example when faced with a similar recruitment crisis in 1948 and give them more money. They certainly deserve it!

Another issue that needs to be tackled is the accessibility of GPs and other community based services. The closure, for example, of the Monks Road Walk-In-Centre mystifies many people, me included, especially when a consultation exercise produced massive support from the public for its remaining open.

I would say about the people who organised it and clearly ignored its findings that there is no wonder that many people have no confidence in those appointed to oversee health and other public services.

You may recall the old proverb, ‘Health is better than Wealth”. Diseases like cancer are no respecters of status or rank. There will probably never be enough money to satisfy all health demands but it seems pretty clear to me that what we are paying at the moment is just not enough.

Whilst I did understand the thinking behind the austerity strategy, Health and Social Care is one area of our daily lives at least where this strategy needs urgently to be reversed.