A somewhat triumphant lady lawyer on this morning’s Today programme was celebrating her success in preventing the Health Secretary from sorting out an unholy mess in some of London’s hospitals. I thought her smug pleasure at having cost the NHS huge legal fees and in bringing to a halt attempts to sort out a financial black hole left by bad PFI schemes and to re-balance healthcare between primary and secondary provision highlighted so much that is blighting our country at the moment.
We continue to treat the National Health Service as if it were a state religion in this country. Indeed, we treat it much better and more reverentially than we do the poor old Church of England! The NHS cannot be questioned; it can do no wrong. The governments of Blair and Brown threw money at the NHS and the coalition government continues the pattern by exempting the NHS, together with foreign aid, from the cuts facing the rest of central and local government. Despite a near doubling of its budget during the Blair/Brown year, there has been nothing like a doubling of its output either in quantitative or qualitative terms.
We also have a fatal addiction to bricks and mortar that brings hordes of citizens to the streets to protest against any attempt to rationalise health care provision with MPs, fearful for their majorities, backing residents’ demands to keep open hospitals they know should be closed. We also have doctors who are paid twice what they earned when Blair became PM and £40,000 more than we pay our MPs but who have abandoned their patients during “off-duty” hours. No wonder there are rows over A&E departments filling up when people cannot contact their GP. No wonder the 111 service is described as “A shambles beyond belief”.
Mark Porter, who is Chairman of the British Medical Association was also on the Today Programme, castigating the government for its actions in Lewisham. It is easy to forget that the BMA is the doctors’ trade union in the UK. It was the BMA that turned over the last Labour government by simultaneously negotiating a huge increase in their pay (averaging over £100k pa) and a drastic reduction in working hours. GPs largely abandoned their old practice of out-of-hours availability with the result that foreign doctors with little English became accustomed to flying in to do a weekend shift at a huge fee and flying back home again.
I am afraid there are two huge areas of public service spending in this country where the service is free at the point of delivery, is administered as a monopolistic monolith and has consistently failed to meet the country’s needs. They are the National Health Service and education. I fear that people who see a service as without cost to them will invariably not value it and will not understand how it operates. We have seen it in the cavalier way in which people with minor ailments turn up at A&E; in people who fail to keep appointments with their GPs or practice nurses; in people who fill their doctor’s surgery week after week with ailments that can only really be cured by the exercise of will power and rational behaviour.
Michael Gove has set about reforming state education by breaking the monopoly power of the teacher unions and the department for education and handing schools back to local people. I have always believed that a voucher system, enabling parents to place their child in any school of their choice to the ceiling value of the voucher would have revolutionised education ad raised standards in this country. It was probably always a step too far to gain acceptance, particularly when we have to share power with the leftward-leaning Liberals but I think Gove’s reforms move us as far along that path as is presently achievable and I am sure they will raise standards for our children. I do not see the changes that Andrew Lansley started and that Jeremy Hunt has inherited changing the beast that is the NHS for the better. That is frightening, given the state of our national finances and the demographic trends we all face. With social care in turmoil and the health care system incapable of the major surgery it needs, it is difficult to see how we can hope to create a health and social care system that is fit for purpose.