Arrested Development

The NHS is sixty years old this year. It has grown into a very big business, but has it changed otherwise?

From the outset, whatever social hopes there were, it was obvious that a state-run "free" health service financed by tax would be over-used and under-financed, and subject to enormous bureaucratic waste.

These problems have persisted, partly reduced by hiving off services such as dentistry to private provision and care in the community to local authorities and private care homes. In addition, charges have been introduced, for prescriptions, "keep" in hospital, charges in dentistry, and the service has survived because many families have performed heroically in nursing relatives at home.

These creeping costs and disposal of responsibilities are a reflection of the fact that financial pressures have resulted from inadequate National Insurance contributions over our life-times and rapidly rising costs due to both health technology cost increases and increased provision for elderly people who are living much longer. In some ways the contributions and demands mirror the problems being encountered in pension payments.

It remains true that the NHS is unique among developed countries in providing free, tax funded, health treatment. As somebody said, the only other country remotely like us is Cuba, where they have encountered the same problems.

Within the last ten years we have ignored the usual restraint on funding, - that taxpayers will not accept the sweeping tax increases, and we have increased funding enormously. The result has been that certain indicators have improved, particularly waiting times for operations, - although they are not matching the situation in most of the rest of Western Europe.

However, we are still among the worst in Europe for cancer survival, death from strokes, and hospital acquired infection, and general health productivity as outcomes for inputs has declined. There are complaints about "postcode lottery", and vast differences between regions, - outcomes in the North being markedly worse than those in the South.

How many people still believe that our centralised, monolithic, bureaucratic service is the best systemin the world? Many of its advocates almost certainly have a vested interest in still arguing that it is the best in the world, when it manifestly is not.

I am saying nothing new, in repeating the criticism that before and with the pumping in of vast new funding there should have been reform. What may have been suitable for 1948 no longer answers the needs in 2008. The consequence has been that much of the funding increase has produced higher wages and extra administration costs, rather than extra services.

If the service is to reach the best standards in the world it will have to become more flexible, decentralised and using private resources. The state does not have to be the monopoly provider of both finance and provision. To deny this must represent "head-in-the-sand" socialism.