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September 9, 2018

Medicine Balls, Private Eye Issue 1474, 13 July 2018
Filed under: Private Eye — Dr. Phil @ 9:54 am

Happy Birthday NHS?

 The NHS was 70 on July 5, with just five years to wait before all the introspection, celebration and politicisation is repeated for what remains of it at 75. The UK will forever be remembered as the first country to introduce universal healthcare and the last to fund it adequately. The NHS is constantly playing funding catch-up with Europe but nothing can reverse the damage done by decades of parsimony. If we had committed the same percentage of our GDP as Germany to health since 2000, we would have put £260 billion more into the NHS. Germany too sometimes struggles with demand, but not in crumbling estates using outdated equipment and technology, with queues extending down the corridors, patchy access to GPs and millions on the waiting list for hospital treatment. This isn’t about how we pay for healthcare, simply that we don’t pay enough.

Jeremy Hunt hopes that an NHS App will revolutionise the service and end the ‘8am phone scramble for GP appointments’ but it won’t end the desperate shortage of GPs, and the tech-savvy patients will simply jump the queue. In its 70 years, the average annual funding increase over that time has been 3.7%, to absorb the costs of inflation, new treatments and the demands of patients living longer with diseases that previously killed them. After eight years at 1% funding growth, the strictest politically-enforced rationing program in its history, the Office for Budget Responsibility concluded the NHS would need 4.3% growth a year to stay on the road. The Government has pledged 3.4% for the NHS England budget only over the next 5 years, omitting increases for health education, training, public health and organisations such as NICE. This works out at 3% of the overall budget, which isn’t enough to halt the decline of universal care. Theresa May and chancellor Phillip Hammond insisted the money be ‘wisely spent’ and the Pavlovian poodles at NHS England promptly announced 17 ineffective treatments it would scrap to save money. It’s important to embed evidence in the NHS, but blanket bans are rarely sensible and tonsillectomy and varicose vein operations will greatly benefit some patients. Any money saved is dwarfed by the money wasted on continuous political ‘redisorgnisation’ and the fees for lawyers, accountants and management consultants that goes with it, never mind the pharmaceutical industry rip offs. The NHS needs evidence-based reform above all.

Labour is keen to claim all credit for the NHS but its origins go back to the Public Health Act of 1848, which realised the importance of clean air, clean water, nutritious food and humane living and working conditions to health. This realisation was not entirely altruistic, and in part triggered by a shortage of workers and soldiers. On discovering 30% of working class recruits were malnourished and unfit for military service in the Boer War,  a school health service, school meals and school milk were established in 1906.  After the first world war, Lloyd George promised ‘Health for the Heroes’, set up a ministry for health and introduced health insurance but for workers only. Churchill’s war-time coalition agreed the need for a National Health Service, and universal care was an essential cornerstone of William Beveridge’s visionary welfare reforms in 1942. True, the NHS would not have happened ‘overnight’ without the passion and commitment of Labour health and housing minister Nye Bevan, who had to overcome repeated objections from both the BMA and Conservative MPs.  Prior to the launch, Labour Prime Minister Clement Attlee gave a placatory speech thanking all parties for their role in establishing the NHS. This incensed Bevan, who was determined to brand the NHS as a Labour creation. He had also witnessed the harm to his family and community caused by prolonged Tory austerity. So instead of celebrating the eve of the NHS on July 4, 1948, he delivered his infamous ‘Conservatives are lower than vermin’ speech in Manchester, which attracted even more excrement through his letterbox and allowed Churchill to declare he was mentally unwell and should check himself into one of his new NHS asylums.

Some Conservatives joined ‘Vermin Clubs’, including a young Margaret Thatcher, who thirty years later tried to strangle Bevan’s baby and switch to a private insurance system. Her ministers dissuaded her, but instead she started off the internal market that has slowly suffocated the service over 40 years. Thatcher believed that the NHS is for poor people and emergencies, and anyone who can afford to go private should do so.Yet despite the underfunding and over-meddling, the NHS fares well on international comparisons for cost-effectiveness and fairness but lags behind on outcomes. This is largely because the UK has poor public health and alarming inequalities that determine disease incidence and premature death far more than NHS funding levels. The NHS is mainly a National Illness Service, designed to repair and rehabilitate but not to prevent. We dive deeper and deeper into the river of illness, treating the untreatable, without wandering upstream to stop people falling in. Unless more funding goes to into preventing illness, the NHS will not improve. The government is merely turning the funding taps on a little more without putting the plug in. Happy Birthday.