12 Feb 2018
Given that the NHS has been politically ‘weaponised’ (whatever that means) I thought that I would ‘go off piste’ with some musings on whether Donald Trump was actually right about the NHS after all.
The core thinking around the creation of the NHS was that good healthcare should be available to all, regardless of wealth. Launched by the then minister of health, Aneurin Bevan in 1948, it was based very firmly on three core principles, that:
• it meets the needs of everyone
• it is free at the point of delivery
• it would be based on clinical need and not the ability to pay
These have guided the development of the NHS over more than 60 years and remain at its core. The third point is where it has all gone wrong with the 'need' bit being replaced by a 'want/ demand' expectation.
These three core principles were simple, easily understood with expectations forged on what it life was like in a pre 1948 world.
Bevan inherited some very complex plans assembled by the previous wartime Conservative administration, which were the result of many compromises. No surprise there.
He took a fresh look and felt that where medical need existed, medical care should follow and that cost to the state should be of secondary importance.
The history of the NHS is that of an organisation established after a century's discussion on the provision of health services to meet a long recognised need. And rather like the definition of a camel being a horse designed by committee, the mess that we see today was conceived
It appeared at a time when Britain saw health care as crucial to the removal of one of the "five giants" of want, disease, squalor, ignorance, and idleness during post-war reconstruction.
The NHS was an amazing, forward thinking concept, but it was faced with ever increasing costs as a result of sophistication in medical knowledge, medicines and technology, and on the other with the financial restrictions inevitable in a centrally funded service with changing toxic mixes of management, dogmas and political beliefs.
Memories fade. With such a long time passing since it started, and with a myriad of NHS offerings costing so much, it is difficult to know if UKplc would follow the same path today toward that universal health care system.
The NHS was based on principles, totally unlike anything that had gone before in the realms of health care. A very dangerous starting point as we all know from our FCA principle based experiences.
It was financed almost 100% from central taxation. Everyone was eligible for care and even then it included those visiting the UK. People could be referred to any hospital, local or more distant. Care was entirely free at the point of use.
The NHS provided a huge range of services, dental check ups, eye tests, immunisation, foot care, ear clinics, maternity services and many more.
And it will come as no surprise that cost estimates of the NHS were soon exceeded and within three years some modest fees were introduced, in 1952 prescription charges of one shilling, 5p in ‘old money’ and a flat rate of £1 for dental treatment.
So, we fast forward to March 2011, the Department of Health published the NHS Constitution. It sets out the 7 guiding principles of the NHS and your rights as an NHS patient.
They should guide the NHS in all it does.
The NHS provides a comprehensive service available to all
Access to NHS services is based on clinical need, not an individual’s ability to pay
The NHS aspires to the highest standards of excellence and professionalism
The NHS aspires to put patients at the heart of everything it does
The NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population.
The NHS is committed to providing best value for taxpayers’ money and the most effective, fair and sustainable use of finite resources.
The NHS is accountable to the public, communities and patients that it serves
We should remember that in 1948 the population was about 47 million:
• A quarter of British homes had no electricity.
• People often lived in the same town all their lives, near their families..
• There were only 14,500 television sets in the whole country.
• Most families listened to the radio for their entertainment.
• Many homes did not have a telephone or an indoor toilet.
• Cooking was done from scratch using produce grown locally.
• You could only buy fresh food items that were in season, grown in the UK.
• There were only just over a million cars on Britain's roads.
• Petrol rationing remained until 1954.
• Most people used public transport to get around.
• Air travel was mainly for the rich.
• The average weekly wage was £3.90p. Now it is about £500.
The UK population now is about 64.5 million and not much of life in 1948 is relevent any more.
But what is happening is that expectation has been surpassed by entitlement, need replaced by demand, stretching a system to breaking point. And if you add increasing abuses of the service and stupidity, something has to give.
Here are some retrospectives to consider, nothing has been learned at all in the last three years:
But in 2018, it would seem that the NHS is in crisis again. Costs exceed budgets and the 7 principles above seem to be failing in just about every way.
The time has come for a rethink and rather like when charges were made to cover the cost of prescriptions and dental treatment, the time has come to charge for GP and non-life threatening A&E treatments visits. If you do not have to pay, you attach no value to what you are provided, in fact many GP’s are seeing hundreds of hours wasted by patients just not turning up for appointments and giving no notice.
It can no longer be an expectation that the NHS meets the needs of everyone for everything.
The NHS can no longer deliver on the three core principles of 1948 let alone the seven of 2011 and politicians should now recognise that fact. It is not a sign of failure, it is a sign that the system has been destabilised by it’s own open, free access and success.
It can no longer offer treatment that is free at the point of delivery for every person, with every condition or indeed desire for cosmetic demand, genetic engineering or gender change that the NHS can deliver.
In the UKplc of 2018, the NHS service expectation is now based as much, if not more, on clinical want as opposed to clinical need.
And what of the "five giants" of want, disease, squalor, ignorance, and idleness.
Well you decide for yourself if after 70 years these have all been eradicated.
In 1948 these giants were the outcome of war, poverty and social unfairness.
In UKplc today much of the above is caused by poor lifestyle choices, encouraged by the welfare state meant to stop it, political expediency and correctness.
Je suis ‘cross’.
Do send this article to your MP, it may provide a bit of 'blue sky thinking' before it is too late.