Striving for the NHS we want, not the NHS we have

At the age of 11 I was exactly one sticker away from completing Merlin’s 1997 Premier League sticker album – a very important accolade for any self respecting primary school boy back then! In the past two seasons I had been forced in shame to order the last stickers from Merlin – this time I was determined to finish the album myself, but try what may, I could not find a chap called Alf Inge Haaland who played for Nottingham Forest.

Then news went around the playground – Dee Chivers had the sticker! Two minutes later Alfie Haaland was mine, but I had lost something in the region of 20 stickers to get him, including several of the rarer ‘shiny’ club bages. Two weeks beforehand I probably would have traded him one for one. The reason for the sudden escalation in value is evident – it was obvious that I wanted the sticker badly enough that I would pay whatever it took to get my grubby pre-teenage mitts on it, and so Dee had absolutely no incentive to give me a fair price for it (The fact that 18 years on I still remember his name shows how much the injustice rankles!) I was so wedded to one outcome, it never occured to me that it would be less expensive to simply order the sticker by post, or not have revealed the need in the first place!

This anecdote, aside of revealing a rather sorry side to my character, neatly demonstrates a problem in our present politics – attaching such significance to an issue that you lose all sight of the cost, and potentially end up worse off as a result. Since the discovery of ‘issue-based politics’ by social scientists, there is one issue that without fail has a high valence with the elecorate – the National Heath Service. Any politician who dares impugne the honour of NHS or (heaven forbid) express the desire to abolish it, can profitably google ‘P45’ to discover what the electorate would be serving them up in May. Every politician upon becoming leader of their party falls head over heels to proclaim their love for the NHS, and their credentials as the best person to protect a national institution so cherished, that we boasted about it to the world during the Olympic Opening Ceremony in 2012. So emotionally charged is it, that the allegation Ed Miliband wanted to ‘weaponise’ the NHS made headline news.

The reason for this high regard is evident – we are all impacted by matters of health. Most of us are born in NHS hospitals; by extension, many of us will become parents for the first time in NHS hospitals.The NHS is the theatre for some incredibly emotional moments in life: relief when a diagnosis is positive, and shock when the prognosis bodes ill. Tears of joy when an operation succeeds, and tears of grief when you are told the worst. And over all of this – deep thankfulness, because most of the time the NHS does succeed in treating the sick, and all of us appreciate the difference it makes. With such emotional attachment, it is no wonder even those of us blessed with generally good health are righteously indignant that anyone should call the NHS into question.

And yet I am not sure that such devotion actually leads to good outcomes for our health service. When politicians get into a bidding war to top each other on health spending, nobody stops to ask themselves what incentives there are for wider healthcare providers to reduce their costs – they know that the NHS budget is never going to be reduced. Nor am I persuaded that politicians of any political creed decrying that their opponents will ‘wreck the health service’ produces the kind of thoughtful democratic accountability we ought to have for such a large publicly funded institution – the unfortunate example of the Staffordshire Health Trust is perhaps the most prominent recent example where this has gone badly wrong. The problem is, playing the NHS card is very sound politics –  you connect the remark your opponent has made about the NHS and connect it directly to the voters’ emotive experience of the NHS – “What evil types these political opponents are, asking awful questions about our cherished national treasure!”

I was once asked what my stance as a Tory was on the health service – the assumption being that I’d be pro-privatisation! My response was: “The maximum number of people obtaining the greatest amount of care at a sustainable cost.” Yes, it is a politician’s answer insomuch as it does not spell out precise policies – but I think it captures what all of us mean when we refer to the NHS. We don’t want to mortgage our children’s futures for today’s health costs, but we want to ensure the money we spend today goes as far as possible to improve the health of as many people as possible. For me that actually means one very practical policy – don’t let any politician conflate their point of view to make it synonymous with the NHS, and potentially hold us back from improvements that could benefit the nation. They would, as with my schoolboy example, be so doggedly devoted to an ideal that they have failed to grasp whether doing so actually benefits the nation or not. And where it is done purely for politican gain, that person should hang their head in shame for putting politics before service to the nation.

A general rule of aspiration is that we want to leave a world that is better than the one we lived in to the next generation. It because of this hope that my focus is on the NHS we want to have, not the NHS we’ve currently got.

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