General   (General discussion, talk about anything.)

An interesting piece in yesterday's Times from Philip Collins who was at the heart of the Tony Blair government.




The situation is both severe and typical. The NHS will now be permanently “in crisis”. Every so often there will be a flashpoint such as the junior doctors’ strike or a winter surge. December 27, 2016 was the busiest day in the seven-decade history of the NHS; the number of elderly patients waiting on trolleys has trebled. If the prime minister is tempted to take the attitude of “Crisis, what crisis? she would be foolish. Real people are suffering, some of them fatally.

It helps nobody, though, to pretend that this is all the fault of Jeremy Hunt, the health secretary. His intentions for the NHS, despite the wild accusations of some critics, are nothing but good. The problem is much bigger than the identity of the minister or the political complexion of the government. The Office for Budget Responsibility (OBR) has calculated that unless the current productivity rate in health improves, the cost of the NHS will push the national debt to more than 200 per cent of GDP by 2060. We cannot pretend that we can keep finding enough money. As Giuseppe di Lampedusa wrote in The Leopard, “If we want things to stay as they are, things will have to change”.

The first change is to recognise that the National Health Service is not really any of those three things. Variations in quality mean the NHS is a regional service with a national logo. Second, the nature of modern illness, which depends so much on diet, means that health is looked after at home; the NHS is an illness checker and fixer. Finally, the NHS is not a single service. The current problem with A&E occurs because GPs, happy recipients of a crazy contract, are closed or there is no local minor injuries centre, which would be a much better place for many of the people in A&E. Hospitals cannot discharge the elderly because local government cuts — the falsest economy in the sorry history of austerity — have turned a poor social care service into a shameful one. The NHS is the repository of problems, not the cause.