The NHS:
As an independent candidate, I can probably exercise more latitude, and possibly even take more liberties, in my examination of this subject than those who belong to political parties.
At the same time the question very much is whether this issue can be solved politically.
In the first place, what do we mean by ‘our NHS’:
What sense of belonging do we have towards it, what level of identification with the NHS as it currently is, or as it was or as it may yet become with further developments
to clinical excellence and technological advance? What level of National Health Service actually carries our consent, if we examine this objectively and dispassionately, save to the extent our compassion is naturally aroused?
Let’s look first at this question of consent, or ‘meeting’ as an expression of value.
Before 1945 someone who was ill would go to the Dr., or hope to be able to. If they could afford to, they would settle on a price: i.e. the doctor’s normal fee or
maybe some modification to take account of the circumstances.
There would be a meeting point between the Dr’s skills and the patients need, allied to the patient’s ability to pay.
And within this meeting point was also the requisite level of consent from both sides.
At the top end of this the problem may be vanities which the wealthy could afford and which the Dr. himself might regret whilst feeling unable to refuse.
At the bottom end of course would be the difficulties of affording the fees of any sort.
It was to cater for the latter in particular that the NHS was set up.
In 1945, when this was a mandate issue, there was less scope for uncertainty over what was being set up and what therefore carried the public’s consent.
People got ill, people had accidents, people needed surgery to help with childbirth or congenital disabilities as well as for conditions attendant upon sickness, disease and accident.
It was a considerable undertaking but with more readily known and manageable limits.
Since then the growth in NHS provision has been exponential as a result of technological advances and clinical progress.
This has made, arguably, for a very different kind of NHS now to what it was then.
The question now may be ‘if the NHS had not been set up in 1945 but were being mooted now, would we vote for the party that was offering it?
Knowing about its scale and reach, would we think it was something that we could afford on this basis?’
This is hypothetical of course, but it still points up the question of consent.
Many things are treated now that fall outside the original definitions: elective surgery of various sorts for example.
Where do we draw the line here? These decisions are being taken on our behalf by the medical experts concerned:
NICE guidelines for example in relation to drugs or surgeons themselves for example in relation to gender alignment or reversal of gender alignment surgery (according to a radio programme I heard on this subject last week). Limits are drawn in relation to the deserving and affordable cases.
Thus the consent for this at the service provider’s end is exercised on our behalf.
We are only likely to know about this if we are directly concerned, but it is happening all the time.
If we knew more about it, and we had the level of awareness that the doctors or evaluating agencies have, would we place the line in the same place?
Would you say ‘No, you need to go further?’ Or would you say ‘No, you are already going too far’?
The obscuring element in all this of course is partly the scale but it is also the fact that somebody else is not only deciding but is also paying on our behalf.
When we are not directly responsible for payment of something, but delegate this to another,
we lose some consciousness towards it and yet it is this consciousness that represents our consent (think again of the Dr. pre 1945).
So perhaps the Health Service does actually need to be funded differently.
Maybe tax needs to be gathered specifically for this service so that we have a better sense of how much of our tax is being spent on this and how much we wish it to be.
Then we could agree to pay more tax or less according to what we all agreed.
Arriving at this agreement might even require a referendum which might not be so unappealing if we got better at handling these!
Apart from the clinical importance of NHS Services, there is a symbolic importance to its very existence.
Some things belonging to ancient tribes may endure in modern societies of great complexity partly obscured for taking a different form.
In a particular tribe it may have been taboo to shoot down a particular bird for example.
If you had to do so, it would bring sickness and death upon that tribe which may not survive or certainly not prosper as a result.
The bird in question would have assumed that symbolic importance.
Do we feel similarly about the NHS?
Has it assumes such symbolic importance that it has become untouchable and interfering with it would be the end of civilisation as we know it?
Certainly no one political party is going to be willing overtly to admit that it is reviewing or seeking to limit its growth, much less reduce its level of service provision.
It could be important not to confuse the symbolic and clinical aspects.
An important aspect of this too is that the health service is the screen on to which many other ills of society are projected.
Emotional or social difficulties lead to physical ill health as do certain other lifestyle choices. How do we put a ring around that?
How do we deal with these issues at their point of origin, rather than the place where they end up, their destination?
We have a national conversation of sorts around the NHS but if it is not a political football it is certainly a hot potato.
And it is perhaps unfair on the politicians to leave the solution with them because they are being asked to consider something which,
if it did lead to them making a unpopular but necessary decision, would probably see them voted out of office.
This makes the political realm unsuitable for handling questions of this sort.
And yet they need to be handled.
Perhaps again it comes down to having a different budget for the NHS so there is a direct relationship between what you pay and what we get.
And then we are paying out of our own pockets and achieving that ‘meeting point’ which also represents our consensus.
I don’t know how costly that would be to administer but if it was just a matter of specifying what percentage of our taxes are being spent on the NHS
then this would make everything more transparent.
And presumably that is happening already, without being clearly stated.
Perhaps the clarity of statement could help to resolve this issue as much as it can ever be resolved.
Individuals would still be free to give to those who need treatment outside of the agreed NHS provision.
But this would be a personal act of generosity rather than a collective exercise of responsibility.
Charitable giving could be further facilitated (I have ideas) to provide for this. |