2018-11-03 The Spectator

(Jacob Rumans) #1
established 1828

S


ince the Budget, economists have
pointed out that Britain is turning into
a health service with a government
attached. The NHS was protected from what
Philip Hammond calls ‘austerity’, yet it has
emerged as the big winner from his aban-
donment of the old Tory idea that govern-
ment should live within its means. The plan
is for more debt, more spending, more tax
and a lot more NHS. At the start of the last
decade, the NHS accounted for 23 per cent
of government spending on public services:
this figure is now set to rise to 39 per cent.
And then, no doubt, further still.
Simon Stevens, the chief executive of the
NHS, will soon run an organisation that has
more people and money than some Europe-
an Union countries. Meanwhile, the budgets
of many other government departments are
to be frozen or even cut. The Home Office
and Department of the Environment, Food
and Rural Affairs will each lose £100 million
— as will, bizarrely in the year in which we
will leave the European Union, the Depart-
ment for International Trade. Contradicting
Theresa May’s promise to make housing a
priority, the budget for housing and commu-
nities will be reduced by £300 million. The
military will continue in its semi-emaciated
state, while taxes rise to a 30-year high.
What is it about healthcare that qualifies
it for largesse on this scale when other public
services have not been protected? It seems
Gordon Brown taught the Tories to see the
cost of the NHS as the yardstick against
which the performance of all other public
services should be judged. And as another
former chancellor (and editor of this mag-
azine), Nigel Lawson, once observed, the
NHS is the closest thing the English have
to a religion. Yet sooner or later a govern-


ment is going to have to be brave enough
to ask whether the NHS is really the fair-
est and most cost-effective way of providing
healthcare.
There is plenty of evidence to suggest
that it is not. On many healthcare measures,
from cancer survival to hospital admissions
for asthma and stroke survival rates, Britain
comes out poorly in international compari-
sons. According to the King’s Fund, the UK
ranks only 30th out of 195 countries when it
comes to avoidable mortality — deaths that
could have been prevented had effective

healthcare been in place. The answer to sort-
ing out these issues is not simply more money.
At least the Blair/Brown governments
had some ambition towards NHS reform.
They demanded it accept privately run clin-
ics as part of the hospital system and they
set up self-governing NHS foundation trusts
in an attempt to restore local accountability.
The Tories seem unable to come up with
original ideas. Extra money has been pre-
sented as a 70th birthday present for the
NHS (a ruse that Mr Stevens was working
on for several years) but not as extra pub-
lic cash always should be: an investment on
condition of improved performance.
So we have written the cheque with-
out asking important questions. Such as:
should healthcare really be funded almost
exclusively through tax rather than, as it is
in many other countries, through a mixture
of tax, co-payments and insurance policies?
As countries become richer, more money is
spent on health. It should not be unthink-

able that those who can afford it spend their
own money. Why not charge for GP visits, as
the Swedes do, or allow for extra investment
to come directly from patients?
In trying to make everything free at
the point of delivery, we end up rationing
healthcare through that old Soviet device:
the queue. Waiting lists are unheard of in
many other developed countries. In Britain,
they are a fact of life, despite ever-larger
sums being poured into the NHS. Something
is going seriously wrong.
People now live longer lives. This is an
inevitable and welcome trend. But the rea-
son the NHS keeps needing more money, as
the new Health Secretary, Matt Hancock,
points out, is because of awful technology.
The NHS is now the world’s biggest pur-
chaser of fax machines. It uses more than
one in ten of the world’s remaining pagers
(which are not only outdated but cost a
great deal to run).
The wasted time and money is extraor-
dinary. There is no reason why patients
should not be able to manage their appoint-
ments online, or even conduct a consulta-
tion online — indeed, in a few instances,
they can. Yet visiting a hospital or surgery
can often feel like a bizarre throwback to a
pre-computer age.
If extra money is to be given to the NHS,
it must be used to modernise the institution.
The NHS must not remain a technologi-
cal museum. If Hancock proposes a decent
plan, Mrs May should resist the urge to veto
it. For years, the Tories have shied away from
liberalising the NHS from the strictures of
government bureaucracy. They now have
few other options, because an unreformed
NHS could bankrupt the government. If
reform is to happen, it must happen soon.

Unhealthy spending

Waiting lists are unheard of in
many other developed countries.
In Br it ain, th ey are a fa ct of life
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