Podium: The NHS is a prisoner of its past

Extract from the Kathleen A Raven Lecture given by the former Cabinet minister at the Royal College of Nursing in London on Wednesday
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The Independent Culture
THE FIFTIETH anniversary of the NHS provides an excellent opportunity for reflection. Perhaps this lecture, covering the birth and growth of the NHS, can be of interest if it helps to put the NHS into a political and historical context.

The National Health Service's founder, Nye Bevan, held fast to the principle of an NHS funded by the taxpayer, and essentially by no other source. His resignation from the Cabinet on the issue of health charges had the effect of elevating that principle to the status of a dogma.

In my view, that has been an important cause of the strain experienced by the health service ever since. It has been refused sufficient funds from the taxpayer, and has never had anywhere else to turn for money. What is worse, sensible discussion of alternatives has been made almost impossible ever since Bevan very successfully made the NHS into a party political battleground.

Rational debate has become very difficult. Every sort of change, including the replacement of old hospitals by new ones, has been presented for political reasons as an attack on the service. It has made the Tories timid about reform - tending to shift the deck chairs around, rather than addressing the basic funding problem - and it has made Labour cling to the Bevanite dogma of a health service financed only from taxes.

That politicisation has been unhelpful to patients and staff. The paradox is that the Bevan model has led to very tight restriction of health expenditure: Britain is actually spending too little on health. That is suggested partly by international comparison. Stronger evidence still comes from the way in which the NHS has had to cut back on the availability of certain treatments.

It is very difficult today to find an NHS dentist, and whilst patients are treated effectively and, for a number of chronic ailments, such as back pain, many patients may find that their GP has little help to offer.

I am not saying that Britain would do better if it had a different health care system. My point is that it helps to raise revenue in a variety of ways. Putting nearly all of the burden on taxation makes it difficult to bear. Another change is that both the main political parties now favour low taxation. And what Enoch Powell said about governments favouring other programmes such as education ahead of health remains true today. Logic and genuine concern might dictate that we should pursue every avenue to increase the monies available for health care. But we don't, because to suggest any private contribution or any change in funding produces a hysterical reaction. People who make provision for insurance themselves have received very little encouragement.

Because relatively little health care is available in Britain, we have a disgraceful situation where how rich you are really does make a difference to the health care that you receive. Our queues and our queue-jumping are no cause for pride or complacency, nor any reason for us to patronise other countries. The shortages and inequality are a paradoxical outcome from one of the most socialist-looking systems in the world. But the answer to queues and queue-jumping is not to cut back on private insurance, as the Government has, but rather to increase by every means what the nation spends on health care.

It is perfectly possible, for instance, for government to pay for services - so that it remains free at the point of delivery - without owning those services. If the government did not own all the facilities from which it buys services, it would not need to find capital for construction and improvement.

At the end of the NHS's first fifty years, we can be proud that people in Britain do not live in fear of medical bills that they cannot afford.

We can warmly congratulate those many thousands of medical professionals who have given brilliant service to the sick, and pushed so wide the boundaries of medical care. We can celebrate longer life and healthier living.

We are perhaps passing through a moment of national naivete or gullibility, when people live in hope that the government will solve our problems by a policy change here and a new funding initiative there.

But it is not so. The gap between what we spend on health care today and what we "ought" to spend is large, and no party is going to make it up from taxation. Health care needs extra sources of money. I can tell you this because I am not in politics; those who are, must go on pretending that they can solve the problem without changing the system.

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