When it was founded in 1948, the National Health Service was intended to be exactly that - a Service that improved the health of the Nation to such an extent that costs would actually fall as the people became healthier. Oh, how stupidly naive were those who started the ball rolling !
What is now obvious is that, given an ageing population, a widening of what is considered to come under the remit of the Service and ever more rapid advances in medical knowledge and technology, costs will rise ever more swiftly. Of course, every Government wants to have close control over this enormous element of public spending but no Government wants to be the one that ultimately cries 'Enough !'. One of the results is that there has been an exponential growth in the number of administrators involved in monitoring roles of every type, and frequent reorganisations designed to convince the populace that something is being done while, in fact, the Service is actually completely out of control; add to this the increasing penchant for litigation over every possible injustice and the amount of time and money wasted by unnecessary administration has also grown disproportionately.
Handing financial control to GPs, the latest Government wheeze and, essentially, a throw-back to the days of GP Fundholding in the early 1990s, is ludicrous. All those employed in the NHS have their own roles to fill and trying to pretend that doctors have some magical ability to manage an organisation this complex is so daft as to make one shudder in disbelief. Doctors know about medicine and, of course, they should make the medical decisions about their patients without interference from others, but managing large and complex organisations is also a professional skill, and it requires professional managers to do it. Doctors must have a strong voice in this process but they should not be the final arbiters; they do not have the management expertise.
The population has come to expect the NHS to solve all of its medical issues, whether ones of real health or more of social desire. This is a major part of the funding problem that now exists and the Government should resolve the problem by returning the NHS to its original function - dealing with illness and debility. There are many conditions and procedures that the NHS should not involve itself with and these should be dropped from the canon. I refer to procedures and services that are essentially life-style choices, such as abortion, the provision of free contraceptive services, including male and female sterilizations (and their reversals), cosmetic surgery including trans-gender procedures, so-called 'alternative therapies' except where they are of genuinely proven worth, the enormous array of psychological and other counselling services that didn't exist a few years ago, and so on and so on. At the same time, the administrative burden that has appeared over the last 30 years must be removed; there are many staff now engaged in all manner of duties that have been invented in recent times but that are essentially pointless. This is not to say that these staff are not working hard and to the best of their abilities, but the problem is that their jobs are unnecessary or, at least, an unnecessary adornment in these times of financial stringency.
Once reformed in this way, services outside the scope of the 'new' NHS should be funded from personal resources, insurance or charitable sources, they should not be a charge on the taxpayer. We also have to come terms with the concept of old age and death. We do not have any divine right to pass on our accumulated wealth, if we have any, to our children and the State should not be expected to provide for us in our old age except for when there is genuine medical need; we have to accept that we will all become less able as we grow older and we should make our own provision for this. The notion that the State should pay for us all to spend our last years in residential or nursing homes is entirely unsustainable and wrong-headed. It is also wrong that immigrants arriving in this country, who have never contributed anything to the State, are automatically entitled to the same level of NHS care as long-standing residents; as the number of immigrants has risen, the burden placed on various parts of the Service has also risen, again disproportionately, and this must be addressed.
The NHS has to return to its roots and go back to dealing with illness and debility. It cannot continue to be a cure-all for every perceived bodily malfunction and anyone who turns up; there has already been movement in this direction with charges for some optical and dental services and for prescriptions, but now is the time to take this approach much further. If we do not address and resolve these issues quickly, the NHS WILL, indeed, GO TO HELL.
No comments:
Post a Comment