Jeremy Laurance: The health debate we need is not the one you hear

Share

Seventeen weeks of sleepless nights and nail-biting days is a long time to wait to find out whether you have cancer.

Seventeen weeks of sleepless nights and nail-biting days is a long time to wait to find out whether you have cancer.

Labour's pledge that, by 2008, everyone with suspected breast or bowel cancer, urgent and non-urgent, will be seen by a consultant within two weeks of referral has obvious voter appeal.

It will benefit those who actually have breast cancer - about one quarter of the 40,000 new cases diagnosed each year was originally referred non-urgently - as well as those anxiously awaiting the all-clear.

But it risks clogging up surgical out-patient clinics. For every woman with breast cancer, 10 to 15 who do not have it are referred to consultants. If these women are seen more quickly, those with other, possibly more urgent conditions, will have to go to the back of the queue.

All policies that establish new priorities have a downside. The Tory plan to introduce isolation wards wherever they are recommended by the senior nurse or matron to tackle MRSA may cut the number of superbug infections - an objective which no one can criticise. But it will also mean fewer patients can be treated, waiting times will lengthen and patients may suffer deteriorating health or worse as a result.

MRSA infection rates are unacceptable - but reducing them will come at a price if Tory plans are followed.

Although the NHS comes top of most voter's concerns in the election there has been a deafening silence from all three parties on the issues crucial to its future. Cutting breast cancer waiting times, tackling MRSA and the Tory plan to build five new children's hospitals is tinkering round the edges.

What is not being discussed is what happens when the cash runs out in 2007-08? Both opposition parties have agreed to match Labour's plans to raise NHS spending in England to £92.1bn in 2007-08, an average 7.2 per cent annual real terms increase over five years, the largest sustained rise in its history.

Every economic indicator suggests that rate of increase in spending on the NHS will be unsustainable beyond that date. A debate is needed now on how the funding gap that will open up in two years is to be bridged - whether from higher taxes, increased private funding or some form of social insurance. But no party is keen to confront it.

A parallel debate is needed on the impact of the NHS market. All three parties have promoted the concept of a patient-led NHS, without spelling out what it means in practice. Up to now, the NHS has provided most of the health services paid for by the state. In future, it will increasingly manage a market in which NHS and private services will compete for business.

By 2008, patients will be able to choose any hospital, NHS or private, to have their operation provided it can meet NHS standards and the NHS tariff. We could see NHS trusts establish marketing departments to tout for business as they depend on getting patients through the doors on a "payment by results" system.

The outcome is unpredictable. Hospitals may skim the most profitable patients - those having routine operations - while neglecting the chronically ill. Primary care trusts, which will hold 80 per cent of the NHS budget, may flex their financial muscle and hold outpatient clinics in GP surgeries - potentially destabilising the hospitals.

Those are the big questions. We should be thinking now if this is the sort of health service we want and if so how to cope with these pressures. But you will not find it being debated out on the stump.

React Now

Latest stories from i100
Have you tried new the Independent Digital Edition apps?
iJobs Job Widget
iJobs General

Ashdown Group: Technical Presales Consultant - London - £65,000 OTE.

£65000 per annum: Ashdown Group: Technical Presales Engineer - central London ...

Recruitment Genius: Physiotherapist / Sports Therapist

£20000 - £50000 per annum: Recruitment Genius: A Physiotherapist / Sports Ther...

Recruitment Genius: Sales Executive / Advisor

£8 - £9 per hour: Recruitment Genius: Sales Executives / Advisors are required...

Recruitment Genius: Warehouse Operative

£14000 - £15000 per annum: Recruitment Genius: An opportunity has arisen for a...

Day In a Page

Read Next
One 200ml bottle of codeine linctus contains three times the equivalent level of morphine you'd get in casualty if you broke your wrist  

The ‘war on drugs’ consistently ignores its greatest enemy: over-the-counter painkillers

Janet Street-Porter
The author contemplating what could have been  

I was a timid, kind, gentle-natured child, later to be spurned and humiliated – in short, the perfect terrorist-in-waiting

Howard Jacobson
Homeless Veterans campaign: Donations hit record-breaking £1m target after £300,000 gift from Lloyds Bank

Homeless Veterans campaign

Donations hit record-breaking £1m target after huge gift from Lloyds Bank
Flight MH370 a year on: Lost without a trace – but the search goes on

Lost without a trace

But, a year on, the search continues for Flight MH370
Germany's spymasters left red-faced after thieves break into brand new secret service HQ and steal taps

Germany's spy HQ springs a leak

Thieves break into new €1.5bn complex... to steal taps
International Women's Day 2015: Celebrating the whirlwind wit of Simone de Beauvoir

Whirlwind wit of Simone de Beauvoir

Simone de Beauvoir's seminal feminist polemic, 'The Second Sex', has been published in short-form for International Women's Day
Mark Zuckerberg’s hiring policy might suit him – but it wouldn’t work for me

Mark Zuckerberg’s hiring policy might suit him – but it wouldn’t work for me

Why would I want to employ someone I’d be happy to have as my boss, asks Simon Kelner
Confessions of a planespotter: With three Britons under arrest in the UAE, the perils have never been more apparent

Confessions of a planespotter

With three Britons under arrest in the UAE, the perils have never been more apparent. Sam Masters explains the appeal
Russia's gulag museum 'makes no mention' of Stalin's atrocities

Russia's gulag museum

Ministry of Culture-run site 'makes no mention' of Stalin's atrocities
The big fresh food con: Alarming truth behind the chocolate muffin that won't decay

The big fresh food con

Joanna Blythman reveals the alarming truth behind the chocolate muffin that won't decay
Virginia Ironside was my landlady: What is it like to live with an agony aunt on call 24/7?

Virginia Ironside was my landlady

Tim Willis reveals what it's like to live with an agony aunt on call 24/7
Paris Fashion Week 2015: The wit and wisdom of Manish Arora's exercise in high camp

Paris Fashion Week 2015

The wit and wisdom of Manish Arora's exercise in high camp
8 best workout DVDs

8 best workout DVDs

If your 'New Year new you' regime hasn’t lasted beyond February, why not try working out from home?
Paul Scholes column: I don't believe Jonny Evans was spitting at Papiss Cissé. It was a reflex. But what the Newcastle striker did next was horrible

Paul Scholes column

I don't believe Evans was spitting at Cissé. It was a reflex. But what the Newcastle striker did next was horrible
Miguel Layun interview: From the Azteca to Vicarage Road with a million followers

From the Azteca to Vicarage Road with a million followers

Miguel Layun is a star in Mexico where he was criticised for leaving to join Watford. But he says he sees the bigger picture
Frank Warren column: Amir Khan ready to meet winner of Floyd Mayweather v Manny Pacquiao

Khan ready to meet winner of Mayweather v Pacquiao

The Bolton fighter is unlikely to take on Kell Brook with two superstar opponents on the horizon, says Frank Warren
War with Isis: Iraq's government fights to win back Tikrit from militants - but then what?

Baghdad fights to win back Tikrit from Isis – but then what?

Patrick Cockburn reports from Kirkuk on a conflict which sectarianism has made intractable