Wednesday, 19 August 2015

Crisis Coming: What Politicians Are Afraid To Tell Us About The NHS


One of the biggest and longest standing ideological debates in the UK is the one about the NHS. Most people hate the idea of market forces coming in to what they see as an almost religiously sacrosanct institution, created to be free at the point of use by a Labour government in the 1940s, and treasured every decade thereafter. Because people have such an emotional affiliation with the idea of a national health service free at the point of use, you'll find the NHS is the one topic in the UK where you can pretty much guarantee that heart will rule over head.

Alas, the truth of the matter is that unless we have more head and less heart we are going to be in big trouble in the future. The signs of this trouble already exist now, but things will get a lot worse, particularly if people don't start facing up to the reality of the situation. Let me explain what that reality is, and why even in the past 20 years successive governments have had to gently usher in more and more private companies at just enough subtlety to not alarm the electorate (you may also like to note that despite the health care industry being opened up to increased market forces, it has not affected the provision of health care free at the point of use).

Here's the reality of the problem though. When in 1948 Minister of Health Aneurin Bevan spearheaded the establishment of the National Health Service the country was very different to what it is now. Back then supply of health care was greater than demand because we had many more workers for every pensioner, we had less sugar and salt in our diets, and we had fewer diagnosed diseases and illnesses to treat (cases like measles, tuberculosis, pneumonia, smallpox, whooping cough and bodily injuries were the most ubiquitous).

Ministers of the 1940s and 1950s tended to imagine that the speed at which we eradicated existent diseases would outpace the diagnoses of new ones. However, because the ratio of pensioners to working people has narrowed, and will eventually reach a point at which pensioners outnumber working people, coupled with the fact that we've greatly increased our scientific research and medical technology (which means a much bigger health budget), there is a financial black hole in the making as demand is now greater than supply (a situation slightly alleviated by lengthy waiting times).

Add to that the fact that many more diseases and genetic problems have been diagnosed, mental health issues have surged (thanks in part to greater cognitive understanding and our ability to diagnose new conditions we never used to understand), and the fact that an aging population means lots more stress on the health services in terms of heart problems, cancer and diabetes, and it is an absolute sure-fire guarantee that the current NHS set-up simply cannot be sustained. The reality is, our wonderful health service is only going to get even more strained, and only has a chance of enduring at anything like its necessary capacity if prices and value are balanced by the market measure of supply and demand, not politicians scared of losing popularity.

The truth is, politicians are not being honest with UK citizens - they know that the future health service is in dire straits without these market forces coming in to save it, but they are too afraid to be candid about this because they are scared of being unpopular and of their party losing elections.

I don't recall many times when the majority of politicians across the mainstream parties have put aside party politics and been united in agreement on a particular issue (being against Scotland's independence was one such example when they did agree, and staying in the EU will be another - UKIP excepted, of course) - but the future of the NHS is one of those truths about which all parties need to get together and find the courage to stand as a united group and openly admit that the NHS is going to continue to decline in effectiveness and economic viability until market forces come in to save it.

Dream on, of course, that kind of unity never happens - but someone reading this blog post in a few decades henceforth will probably be struck by its prescience, and by how strange it was to think of living in a time when the majority of the people elected to represent us were so indisposed to the idea of telling us the truth about our own health industry.

The sooner more and more of the electorate can accept this and speak openly about it, the sooner politicians will feel less reticent about being able to tell it like it is, and the greater the likelihood that they will do what needs to be done to save its future.

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