No, the NHS is NOT like a Church
Posted by Ricky in Opinion under on Sep 10 2007
The N.H.S. can be described in several ways, but as a ‘Church’, must be among the least appropriate. In a predominately secular society, many churches sadly are just historic sites, largely abandoned by their congregations, with huge maintenance backlogs and an uncertain future. Others suffer the ignominy of deconsecration and conversion to alternative use.
No, the National Health Service is and does exactly what it says. It is an integral, too often taken-for-granted, part of the fabric of our society, but it has many problems.
‘It’s Resources, Stupid, Resources...”
The 2002 Wanless Report (predictably) concluded that we should retain our health model but that it needed far greater resouces - which it has got ,and continues to get, thanks to that courageous tax hike. In truth, the chances of dismantelling and rebuilding a new model, given its totemic status within the Labour Movement, were remote indeed. Perhaps, realistically, a nation can only have one go at creating a comprehensive health system. We had ours in 1948, and we have to do our best with it.
The problem with our model of universal care, free-at-the-point-of-delivery, is that demand is potentially unlimited, resources are definitly finite, and improvements in treatment and new advances incur ever increasing costs. Crudely, the solutions we use are: organisational effeciencies, and artifical limiting of demand. The first, which also includes the controversial use of the commercial sector to radically improve throughput, is what lies behind the recommendations contained in the Fit for the Future proposals. The second is exemplified by N.I.C.E. which conducts labourious cost/benefit analysis on treatments, and the refusal of Health Trusts to fund certain areas of treatment. Recent examples are: N.I.C.E.’s decision not to fund early stage Alzheimer’s treatment (upheld by the High Court), and the widespread refusal by Trusts to fund breast size reduction surgery on the grounds that it is ‘cosmetic’ even when the clinical need is glaringly evident.
In the French system, on the other hand, the cost of treatment is theoretically the responsibility of the patient, but is reimbursed according to two criteria: 1. the ranking that a treatment is given; 2. the economic status of the patient. Thus, vulnerable groups such as the unwaged, the elderly, will be fully reimbursed. As an example, the cost of treating Alzheimer’s’s has been entirely assumed by the state. (see my earlier weblog).
Our system is effectively binary - either yes or no. And we contrive to narrow the ‘yes’ in devious ways.
For this reason, the NHS will always be in crisis. However, in my opinion, the great effort currently being made to reconfigure health provision will wring the best value out of the resources, human, physical and financial, and the Fit for the Future proposals are a pressing opportunity to raise standards across the area, which we should encourage and support.
Make no mistake, KWASH is not about saving any hospitals, it’s Tory scaremongering and mischief making. We are the party of government. We should defend the PCT, an honourable and professional organisation, and not run a populist copycat campaign, which if successful will seriously impact on health provision in Sussex, and on our own credibility.
“We are not tinkers who merely patch and mend what is broken… we
must be watchmen, guardians of the life and the health of our
generation, so that stronger and more able generations may come
after”
Dr Elizabeth Blackwell (1821-1910), The First Woman Doctor
