Editorial
Spin doctoring won't cure the NHS
TONY BLAIR’S vague and unexpected promise on the Frost programme to raise British health care spending to the "European average" over the next six years came after the collapse of repeated efforts by Labour’s spin doctors to escape from the growing crisis on the state of our hospitals.
Worse, Labour’s political line since the 1997 election has been to tinker at the edges of the NHS rather than confronting the real resource problems they inherited from the Tories.
Ministers have promoted expensive but essentially irrelevant gimmicks such as the "NHS Direct" phone service (which some consultants argue has resulted in more people arriving in A&E departments), rubber-stamped costly and controversial schemes for privately-funded (PFI) hospitals which will mean even fewer beds, and pandered to GPs by the establishment of Primary Care Groups while leaving hospital staff outside the NHS planning process.
The pressure on hospitals underlines the folly of the Tory/New Labour line of funnelling huge amounts of cash into primary care (GP) services and giving ever-increased power to GPs in the vague hope that this will result in fewer hospital admissions.
Bed shortage
Far from it: every year since Virginia Bottomley coined the notion of a "primary care-led NHS" more medical patients have been admitted as emergencies to hospitals. With beds in short supply, many of these patients can only be admitted to surgical wards, at the expense of cancelling waiting list operations.
Absolutely all of these problems and bottlenecks which beset the NHS were predicted by campaigners: the Tory policies which led to this collapse of front-line care were one key reason why people voted Labour in 1997, expecting Tony Blair to make a difference.
But two years of Gordon Brown’s stingy Tory spending limits, followed by a half-hearted drip-feed of belated extra cash have left health authorities and Trusts facing massive deficits this year and another year of austerity to come.
Now the Tory vultures are circling, scenting the possibility of nudging Blair and his government even further to the right. All claim to be looking for ways of generating extra resources or "lightening the load on the NHS".
But more and more pundits are hoping that having set his face against any tax increases, Blair can be persuaded to turn instead to promote private medical insurance, the rationing of NHS care, and even the introduction of charges on in-patients for meals and "hotel services" while in hospital. Unfortunately many of these ideas appear to fit in with other "New Labour" nostrums of privatisation, "partnership" and "modernisation".
In some ways the situation is reminiscent of the winter of 1987-88, in which a barrage of press headlines on the state of the NHS forced Thatcher to come up with a short-term handout, while instigating her secretive "review" which culminated in the reactionary, market-style reforms of 1991.
Rejected
All of the schemes which are now being recommended to Tony Blair were explored – and ultimately rejected – by Thatcher and the Tory right as they looked for ways of privatising more health care in the late 1980s: they were not politically viable then, and they are not now.
Private medicine remains massively unpopular (still fewer than one person in eight has private cover, most of those through company schemes), expensive, poor value and highly selective in what it will treat, leaving the NHS to cover emergencies, chronic illness and expensive conditions.
Because most people in hospital beds are elderly and/or poor, imposing charges for treatment or hospital stays involves either costly and complex bureaucracy to administer exemptions, or grotesquely unfair charges on those least able to pay.
One significant difference is that in 1987 Thatcher had just won the election six months earlier, and had a full electoral term left to see through her "reforms".
By contrast the Blair government is already more than half way through its first term, and must find ways to make a difference quickly if it is not to face another similarly bruising winter before the next election.
His pledge on the Frost programme of extra money over the next six years would be more welcome if he had defined how much he meant and told us where it would come from.
European countries spend an average of 8 percent of GDP on health care – but this average is lower because it includes low-spenders such as Britain, Portugal and Ireland. France spends 9.6 percent and Germany 10.7 percent, compared with 6.8 percent in Britain.
But a much larger share of health spending flows through the private sector in most of Europe compared with Britain, and most of these have complex, insurance-based systems carrying heavy administrative costs.
Cost
Estimates vary as to how much Blair’s pledged extra funding would amount to in real terms – or where it would come from.
With British GDP currently running at £900 billion, to reach the European average of 8 percent would imply an increase of around £20 billion on the current annual spend on NHS careand private medicine over the next 6 years.
If it all came from government and went on the NHS it would be the equivalent of 10p on income tax – but this would also raise substantially more than most campaigners believe to be necessary to enable the British system to cope with the various demands of the 21st century.
The simple step of scrapping the ceiling on National Insurance contributions for the high paid would raise up to £3 billion: increasing the employers’ share of National Insurance (currently around 50 percent of the European average) could easily raise billions more.
These steps alone, taxing the rich and big business, would easily provide enough to expand our health services to meet the demands of the new century, end low pay in the NHS, scrap PFI, build new state-funded hospitals, and halt the scandalous means-testing of long-term care for the elderly.
A thriving NHS has always been the best answer to the parasitic claims of the private sector.
This winter’s lesson must be that spin doctors cannot compensate for a policy failure on health.
Gordon Brown must be told to open up his war-chest of surplus cash and start the treatment now to revive the NHS.