Tuesday, 20 January 2015

Why can't we talk about the NHS?

It is with not inconsiderable trepidation that I sit down now to write a Blog post about the National Health Service.  It can be a pretty touchy subject.  Unfortunately, this is a big part of the problem.  Although I feel pretty positive towards the NHS in general, I find that few things irritate me more in the realm of political discourse than the apparent beatification of the Health Service, and the way in which so many people are seemingly so incapable of discussing health policy rationally.

The NHS is a good institution – but that doesn't mean there is no conceivable way in which it could be improved.  Even a statement as benign and self-evident as that one, however, is tantamount to high treason in some people's eyes; even to hint that the NHS is anything less than a million percent perfect is proof positive that one is an enemy of health, of the state, of civilisation itself.  And remember, it's not just 'the NHS' – it is your NHS; our NHS; THE PEOPLE'S NHS.  It is the envy of the world.  In a recent survey event all about the NHS by the pollster Lord Ashcroft, the NHS was described by one respondent as 'the soul of the country'.

This is not a healthy state of affairs.  The amount of ludicrously emotive, hyperbolic rhetoric surrounding the Health Service – along with the idea that it should somehow be above scrutiny, and above reproach – makes it impossible to have a rational, objective discussion about the challenges (and there are challenges) facing the NHS today.  This was particularly brought home to me while reading Lord Ashcroft's Report from his NHS polling; I have long felt baffled and confused by health campaigners telling us that the NHS is constantly 'in crisis' or in need of 'saving', and yet opposing any and all attempts to improve or reform it – Lord Ashcroft's meticulous research, however, shows up a far greater number of paradoxes in the way people view one of our most important public services.

Ashcroft found, for example, that consistency of care (as opposed to the dreaded 'postcode lottery'!) was an important issue, with 72% of people asked saying it was important to make sure healthcare varied less from one hospital to another, or between different areas of the country (and as many as 60% thought the government should 'set standards and targets that all hospitals must meet').  At the same time, however, more than half the people in the survey (57%) supported the idea of decisions being taken 'at a more local level' to 'ensure the needs of each particular area are met'.

Another strange dichotomy which struck me was that although people were not overly bothered by where they got treated, provided the quality of care was good, or by being able to choose which hospital they were sent to (which is a blow for the recent drive to introduce more 'choice' and 'convenience' into the health market), they still opposed the closure of local services.  Only 35% of people placed a great importance on 'being treated near your home', when asked what aspects of the Health Service they thought were most important, while 79% described 'high quality of medical care' as 'very important' – and yet, despite placing relatively little value on being treated close to home, when asked what the government should consider to help fund the NHS in future only 36% of people said the they should consider 'closing some local hospitals to consolidate services into bigger, more efficient units with expert staff'.

Ashcroft's survey also uncovered a remarkably entrenched view from many of his respondents.  21% of people say they would oppose the use of private companies to deliver NHS service, even if this would mean a better standard of care.  This stubborn view that 'private' is axiomatically bad – even when the results are positive – and needs to be warded off with a shaman's stick is the determined dogmatism of blinkered ideologues.  That's not to say that more private sector involvement is the answer to issues with the NHS – there is a distinct possibly that it isn't – but to dismiss the idea out-of-hand, refusing even to consider the benefits such an option might bring and weigh them up against any possible negatives before making an informed judgement, is supremely foolish.

The NHS is a public service, paid for out of tax money – and, as such, the public deserve to get the best possible service for their money.  We don't get emotionally attached to other public services like London buses or councils' bin collections, and feel a great need to defend their honour as we would our own children whenever anybody casts aspersions upon them.  In politics, everything should be up for discussion.  How else do we improve things?

If the NHS can be improved – if healthcare in general can be improved – that is unquestionably a good thing, and something we should welcome.  We need to consider all options, and debate the pros and the cons without getting hysterical; without thinking that those who disagree with us are evil bloodsucking vampires who want to roast babies like marshmallows and eat them squeezed between digestive biscuits, instead of simply being people offering a different solution to challenges which affect us all – a solution which we may not have considered ourselves; and without placing a higher value on the concept of a National Health Service (in its current guise) than on people's health and people's lives.

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