What’s the point of the NHS?

Most people agree that the point of the NHS is to provide health care free at the point of delivery. Doctors for Reform are notable exceptions, arguing that you should pay to see your GP, but they are considered by most in the profession to be a right wing fringe even if they do appear to have Lansley’s ear. Free care may be one of the principles of the NHS, but it is not the most important.

More importantly, the point of the NHS is to distribute health care according to need.

As John Lanchester describes in his gripping guide to the world of finance and the economic crisis, “Whoops!”

“Capitalism is not inherently fair: it does not, in and of itself, distribute the rewards of economic growth equitably. Instead it runs on the basis of winner takes all and to them that hath shall be given. For several decades after the second world war the western liberal democracies devoted themselves to the question of how to harness capitalism’s potential for economic growth to provide better lives for ordinary people. The jet engine of capitalism was harnessed to the ox-cart of social justice. This was the cause of much bleating from advocates of pure capitalism, but the result was that western liberal democracies became the most admirable societies the world has ever seen. Not the most admirable we can imagine, and not perfect; but the best humanity had as yet been able to achieve. Then the Wall came down, and to various extents  the governments of the west began to abandon the social-justice aspects of the post-war project. The jet engine was unhooked from the ox-cart and allowed to run off at its own speed. The result was an unprecedented boom, which had two things wrong with it: it wasn’t fair and it wasn’t sustainable.

Notwithstanding the contraversial (to some) link that Lanchester makes between the collapse of the Berlin Wall and the unhitching of social justice from the economy, the gross and widening social-economic inequalities over the last 30 years are beyond reasonable dispute.

The Tory Health White Paper, like the New Labour policy that preceded it is based on the ideological conviction that the ox-cart of the NHS is holding back the jet-engine of commercial healthcare.

The historian Tony Judt gives the unhitching a more detailed analysis in his recent book, ‘Ill Fares the Land‘

Markets follow the money. Goods are distributed not where they are needed but where the money is. Consider any commodity, food for example. There is plenty of food to feed everyone on the planet, but while rich countries are facing an obesity epidemic and throwing away millions of tonnes of food every year, millions of people in poor countries are still dying from diseases related to malnutrition. See the excellent book “Stuffed and Starved” by Raj Patel, or take a trip to Hoxton market near my surgery (4 jumbo bags of Dorito’s for £1) and Broadway Market in a ‘nice’ part of Hackney (organic truffles £1 each).

Markets lead to crap for the poor and indulgence for the wealthy. Too little care for those who need it, too much for those who don’t. Bevan knew this over 60 years ago when the NHS was born, under worse economic conditions than we’re experiencing now. Bernard Shaw knew it a century ago:

And every hypochondriacal rich lady or gentleman who can be persuaded that he or she is a lifelong invalid means anything from fifty to five hundred pounds a year for the doctor. Operations enable a surgeon to earn similar sums in a couple of hours; and if the surgeon also keeps a nursing home, he may make considerable profits at the same time by running what is the most expensive kind of hotel.

Meanwhile the sickly poor had to make do with charity or nothing.

There is another point to the NHS, of less obvious importance than free care distributed according to need, but of profound importance to our society. The NHS binds us as a society together. Everyone who contributes to the NHS can feel condident that no matter how we feel about the work we do, roughly every 11th hour we work can be considered our contribution to the care of people who need it. We can be (or could be) assured that people less fortunate than ourselves, thanks to us, are being treated by the NHS. Because of the government’s ideological conversion of the NHS from a public service to a commercial business, the NHS will become nothing more than a brand. There will be no NHS care any more. The money, instead of being spent on care for people who need it, will be given to a commissioning organisation that will pay private companies and give them the right to use the NHS brand. Our money will go to private companies who will divide it between care and shareholders, keeping the maximum possible for their shareholders. We will loose an institution that binds us together. As Sir Ara Darzi said in his resignation letter to Gordon Brown last year:

“The NHS is the greatest expression of social solidarity found anywhere in the world: it is as much a social movement as it is a health system. It is not just that we stand together but what we stand for: fairness, empathy and compassion. It is for these reasons that we all care so deeply about its future; and it is why I stand ready to contribute to ongoing efforts to invest in and improve the NHS, in any way I can.”