Britain’s doomed NHS is only a symptom of a deeper malaise

My Facebook timeline has, for weeks, been furious at Jeremy Hunt. All this might tell you is that I am friends with the type of people who feel comfortable expressing extreme anger – sometimes hatred – towards politicians. They are mostly middle class, soft left voters, many of whom work in the public sector or have relatives who do so. Several of them work in the NHS, and a couple of them are the very junior doctors at the centre of the maelstrom engulfing the UK’s Health Secretary, who has confirmed his place in the rhyming slang lexicon.

I don’t really intend to add to the debate over the junior doctors’ contract. jeremy_hunt_visiting_the_kaiser_permanente_center_for_total_health_700_second_st_washington_usa-3june2013Hunt is a politician who was shown to be incompetent and cowardly during the BSkyB scandal that, in another age, would certainly have led to resignation and disgrace. It is no surprise that he has proven incapable of managing extremely delicate negotiations and even of using appropriate rhetoric in his current role.

However, the role he currently has is also very definitely a poisoned chalice. Simon Jenkins’ Guardian column last week, although veering into swivel-eyed nonsense towards the end, was sharp on the public’s unthinking adoration of the NHS. Political parties in the UK are acutely aware of the “sacred cow” status that our health system enjoys. The Conservatives introduced the idea of a ring-fenced NHS budget in 2010 for precisely this reason. But that adoration is only one of the reasons why the NHS is doomed.

The NHS is badly out of date. It is a gargantuan, centralised, socialist system in a splintering nation populated largely by choice-craving, wealthy, individualistic and indolent capitalists. The junior doctor row is ironic chiefly because it is part of a government attempt to placate citizens by honouring a manifesto commitment to seven day services. We want more from our public services, but not at our own cost.

The conditions for such a system to be politically feasible could only have existed in the aftermath of a shared disaster so awful as to create a newly defining sense of collective identity for the nation that would linger for several decades. It’s no surprise, then, that it was created in 1946, albeit in a tragically different form than that proposed in the Beveridge Report.

There are things that could possibly be done to save the NHS aside from throwing more money at it. Andrew Lansley’s ill-fated reorganisation during the coalition government hinted at some of these: the need to reduce political intervention and restore local oversight, for example. However, it also failed on many measures. For one, it put huge amounts of money in the hands of GPs, a producer interest group. For another, it substantially failed to force NHS institutions to work in an integrated way with the local councils responsible for commissioning social care.

That last point hints at the real problem facing the NHS. Ultimately, its slow decay is only a visible symptom of a deeper malaise. And that malaise stems from a broken political system.hqdefault The Conservatives knew that the NHS was their weakness back in 2010, hence their much-mocked campaign slogan: “I’ll cut the deficit, not the NHS.” Yet now, the Health Secretary can wage war with the doctors’ union and incur the wrath of the vast majority of voters without any real political damage being done. The only thing that has really changed is the state of our politics.

Amol Rajan, the editor of the Independent, has written eloquently this week about how concerned we should be about the state of Britain’s democracy. It is a subject I have also touched on several times (here, here and here, for example). But Rajan does it better. In a tour de force finale, he invokes the “generation of men and women” who “often died young” in the name of power to the people, and concludes:

Barely two generations on, we are forfeiting [democracy] by sheer indolence, sleepwalking into the very tyranny from which they thought, and prayed, they had delivered us.

The anger on my Facebook timeline shows that politics can still rouse strong feelings in ordinary voters. In the case of the junior doctor contract, anger is arguably justified, although I wouldn’t personally consider the BMA the saintly trade union that others seem to. But none of this changes my view: anger is welcome, but it would be better directed not at the symptoms but at the failing political system that created politicians like Jeremy Hunt and public services like the NHS.


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