In the days before the NHS, it really was a case of survival of the fittest. If people were ill, they often died. Life expectancy was low, in the early twentieth century 63% of people died before reaching the age of 60. The average life expectancy of boys born in 1901 was just 45 and for girls 49. In subsequent years, there were improvements and, (despite the impact of the First World War and World War II) average life expectancy rose to 63 by 1940.
Now, the work of the NHS and preventative services has further helped to increase life expectancy to 78 for males and 83 for women, with prevention being one of the most valuable ways of promoting a long and healthy life. This afternoon Andrew Lansley addressed the Conservative Party Conference to try to justify his programme of NHS reform. Before I go into that though, a brief history lesson in healthcare:
Prior to the NHS, the responsibility for healthcare lay solely with medical professionals who would treat the sick, either through charitable work with the Poor Law hospitals or, more commonly, by seeing patients who paid them directly. Most importantly, no one was responsible for prevention. In fact, because medical professionals were paid for treating people, where was the incentive for them to promote healthy living and avoidance of disease?
Absolutely every aspect of medical care had to be paid for, which for poorer families meant they just could not afford decent care and had to rely on home remedies and treatments purchased from a local pharmacist. If any of you have seen the “Victorian Pharmacy” series on BBC, you will have seen an example of one part of that system.
This all added up to significant problems both with the standard of healthcare, and with access to it. To address the inequality in access to health, in 1911, Lloyd George created the first version of National Insurance. For those who could afford the flat-rate contributions, cash benefits for illness were paid via insurance companies, at a fixed rate, irrespective of how serious the incapacity. There was access to GPs, but this was very limited and hospital care was only given in the most severe of circumstances. But, what about those who could not afford to pay?
The Poor Law was the only protection for those who were at the bottom of the scale. The desperately poor had to make do with charitable aid, voluntary hospitals and workhouse infirmaries. The huge differences in standards of healthcare meant that the government was unable to provide for all those who needed it. There was little or no consistency and nothing was based on need, rather on ability to pay.
The NHS was created to strike a balance between the need for universal healthcare and the need for a system that health professionals could support.
So, to Andrew Lansley. Despite Conservative proposals for NHS reform being slammed by the public, the Royal College of Nurses and the British Medical Association, Lansley and Cameron remain dogged in their pursuit of NHS destruction through “slash and burn cuts.” To carve up healthcare and produce a system that is based on profit, not on patient care.
I am concerned on many, many levels with the proposals for NHS reform, not least because the government just isn’t listening. Despite paying lip-service to a consultation exercise and making cosmetic changes in a vain attempt to appease opponents to their Health and Social Care Bill, no-one is convinced. The bill is still an attempt to carve up the NHS to such a degree, that this time, Labour will never be able to restore it.
The truth of the matter is that Tories just cannot be trusted with the NHS.
Earlier this week, in an open letter to the Lords ahead of them debating the bill next week, more than four-hundred Doctors and Health Professionals made it clear that in their opinion, this bill will be a devastating blow to the NHS. Creating a health market-place and “commercialisation” that will “fragment patient care [and] aggravate risks to individual patient safety…” So we will be headed to a system similar to that we had in the early twentieth century, a patchwork quilt of mismatched fabric, with huge differences in the standard of healthcare available and no central control over quality, service or access. A system that health professionals do not want and importantly, that patients and the general public do not want.
One of the problems that health professionals predict is the damage to medical ethics and trust. If Doctors have one eye on the balance sheet, will they always offer the most effective treatment, or go for the option that is cheaper, to see if that works first. The Doctors are right to worry, this system sets up a scenario where Doctors are no longer trusted to give the best care, patients will question the motive behind Doctor’s decisions and rightly so. Healthcare is no marketplace and NEVER should be.
Doctors are not accountants; they will not want to sit pouring over spreadsheets and accounts, after a long day caring for patients. At the very least, private accountancy firms will be engaged to provide the service with hugely inflated fees for doing so. The private sector love public sector contracts, for all the wrong reasons. As Dr David McCoy, Associate Director of Public Health for Inner North West London, told Channel Four News:
“There are a large number of sharks circling around the NHS. For some people the NHS is an unopened oyster capable of generating high income streams and profits.”
There will be no other outcome, than a system of healthcare that favours the wealthy and relies on charity for the poor. This is nothing to do with saving money, this will be a wasteful and destructive exercise, damaging the health service and leaving the public at risk. As I have said previously, the NHS is a neon-sign that points to a more equal society. This bill will undermine that and bring us a deterioration in standards, with a widening gap between rich and poor and no central body with responsibility to ensure demand for healthcare is based solely on need, not on ability to pay or the fiscal abilities of your GP.
The truth is in the detail, in the Conservative NHS Improvement Plan, which I have read, wiping blood from eyes as I did so, David Cameron says:
“Incentives must replace targets, and people and professionals, not politicians, should decide how our public services are run.”
If he truly believed what he says here, he would surely listen to the millions of people and health professionals, who are shouting at the tops of their voices
“Oi, Dave, NO!”