How should we regard the NHS as it celebrates its 70th year? A much-loved elderly aunt who offers nothing but care and support to an increasingly demanding family despite being rather down on her financial luck? Or something more like the septuagenarian occupant of the White House: an over-fed attention seeker who constantly disrupts any attempt at rational conversation?
Judging by yesterday’s performance at the parliamentary liaison committee, the PM clearly favours the more affectionate portrayal. The early birthday present Mrs. May offered up was the promise of more money as part of a multi-year funding settlement. The NHS won’t even have to wait until 2019’s spending review to get the cash. Coming on top of the new pay deal for staff, it is turning out to be a very special year for the health service.
The PM is of course right that the NHS is facing rapidly growing levels of demand. She is also right that funding for the health service has not kept pace with that demand. But any even-handed survey of the public sector immediately reveals that this is hardly a unique situation.
As councils know only too well, rising demand is a fact of life affecting not just adult social care but also children’s services. The pressure on schools, police and welfare are growing. Councils are even having to deal with more demand for environmental services as incidents of fly-tipping rocket. Add to this the fact that the Department of Health is the only major spending department to have enjoyed a funding increase since 2010 and other public sector workers may well be concluding that the NHS bears a closer resemblance to an amber billionaire than a kindly aunt.
So why does the NHS get singled out for this special attention from policy-makers? Simply because it’s the NHS. It’s the “national religion”, the “world’s greatest institution”, staffed by “angels” and “heroes”. There are no votes to be lost in giving it more money. But this adulation erodes rational policy-making and ultimately damages the very health service politicians are seeking to help.
The NHS is an organisation primarily focused on acute care and responding to incidence of illness. The rise in demand for its services cannot be solved by simply throwing more money at meeting that demand. To do so is rather like reasoning that the best treatment for alcoholism is to make sure the alcoholic has enough money to buy whisky. Ultimately the solution to rising demand in the NHS and in all other services is to fund prevention and early help. That means thinking far more holistically about a decent, long-term settlement for public health, social care, welfare and children’s services alongside the NHS. It also means making a serious investment in shifting all public services towards preventative rather than curative models.
Whether the PM and her Cabinet would ever consider embracing this common sense is a moot point in the face of NHS idolatry. But as many families know there comes a point when a troublesome relative, no matter how loved and elderly, can benefit from a couple of home truths.