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| The only way to protect our NHS? Set up a National Care Service | The only way to protect our NHS? Set up a National Care Service |
| (3 months later) | |
| There’s so much of modern life we take for granted, but not the NHS. It has a special place in British hearts, outranking the armed forces and the royal family in what makes us proud to be British. But the NHS is facing two existential tests on its 70th birthday, both of which exert big cost pressures. | There’s so much of modern life we take for granted, but not the NHS. It has a special place in British hearts, outranking the armed forces and the royal family in what makes us proud to be British. But the NHS is facing two existential tests on its 70th birthday, both of which exert big cost pressures. |
| Back in the 50s, much of its work involved doling out treatment for one-off illnesses such as pneumonia and tuberculosis. Today, those serious infections are less common and the greatest demands on the NHS come from chronic conditions that people can live with for decades – diabetes, cancer, dementia – some associated with unhealthy lifestyles. | Back in the 50s, much of its work involved doling out treatment for one-off illnesses such as pneumonia and tuberculosis. Today, those serious infections are less common and the greatest demands on the NHS come from chronic conditions that people can live with for decades – diabetes, cancer, dementia – some associated with unhealthy lifestyles. |
| There is also a dark side to the good news story that each generation is living longer: some of us will also experience protracted and complicated periods of ill health in old age. It costs five times as much to care for an 80-year-old as a 30-year-old, and those costs are felt sharply in ageing societies with a declining proportion of working-age adults. | There is also a dark side to the good news story that each generation is living longer: some of us will also experience protracted and complicated periods of ill health in old age. It costs five times as much to care for an 80-year-old as a 30-year-old, and those costs are felt sharply in ageing societies with a declining proportion of working-age adults. |
| Some have used these rising cost pressures to raise a giant red herring. They argue we can no longer afford the NHS: it will either cannibalise all other public spending or result in eye-watering taxes. To keep costs down, they say, we need to embrace an insurance-based system with more private providers. But what the anti-NHS brigade fail to acknowledge is that every ageing society that drinks and eats too much faces these fundamental challenges; they don’t just afflict those socialist enough 70 years ago to create an NHS. All industrialised nations spend more of their income on healthcare as they get richer, and we’re no different. The NHS in fact ranks very highly internationally on efficiency and social equity. The US, with private insurance, spends vastly more, with poorer – and dreadfully inequitable – outcomes to boot. | Some have used these rising cost pressures to raise a giant red herring. They argue we can no longer afford the NHS: it will either cannibalise all other public spending or result in eye-watering taxes. To keep costs down, they say, we need to embrace an insurance-based system with more private providers. But what the anti-NHS brigade fail to acknowledge is that every ageing society that drinks and eats too much faces these fundamental challenges; they don’t just afflict those socialist enough 70 years ago to create an NHS. All industrialised nations spend more of their income on healthcare as they get richer, and we’re no different. The NHS in fact ranks very highly internationally on efficiency and social equity. The US, with private insurance, spends vastly more, with poorer – and dreadfully inequitable – outcomes to boot. |
| That doesn’t, of course, mean we can kick back smug in the knowledge that Britain does healthcare better than anywhere else. The fact that we lag behind internationally in treating the most common causes of death shows we don’t. And there are two major hurdles to overcome in making the NHS fit for the future. | That doesn’t, of course, mean we can kick back smug in the knowledge that Britain does healthcare better than anywhere else. The fact that we lag behind internationally in treating the most common causes of death shows we don’t. And there are two major hurdles to overcome in making the NHS fit for the future. |
| First, public affection for the NHS can be a mixed bag politically. On the one hand, it can deliver big boons: there’s a reason why it was the NHS that featured on the side of a Brexit battle bus. It’s the only area of state spending that enjoys overwhelming public support for tax rises to fund it. But get the politics wrong, and catastrophe can ensue. MPs have lost seats defending hospital reorganisations that experts say need to happen but that result in local closures. Even reforms that have unquestionably saved countless lives – such as the consolidation of London stroke services from 31 hospitals into eight specialist centres – were hugely contentious. And this was all in a time of plenty. Who will believe the downgrading of a local A&E is about improving care, given today’s financial strains? | First, public affection for the NHS can be a mixed bag politically. On the one hand, it can deliver big boons: there’s a reason why it was the NHS that featured on the side of a Brexit battle bus. It’s the only area of state spending that enjoys overwhelming public support for tax rises to fund it. But get the politics wrong, and catastrophe can ensue. MPs have lost seats defending hospital reorganisations that experts say need to happen but that result in local closures. Even reforms that have unquestionably saved countless lives – such as the consolidation of London stroke services from 31 hospitals into eight specialist centres – were hugely contentious. And this was all in a time of plenty. Who will believe the downgrading of a local A&E is about improving care, given today’s financial strains? |
| Many expensive, chronic conditions are preventable. But the sort of health service that encourages us all to have a healthier lifestyle looks markedly different to the NHS of stripy pyjamas and wrought-iron bedsteads that featured in the opening ceremony of the London 2012 Olympics. While it’s a political nightmare to close a poorly performing stroke service, it is relatively easy to cut stop-smoking services, which attract less public attention, and that’s exactly what’s happened. | Many expensive, chronic conditions are preventable. But the sort of health service that encourages us all to have a healthier lifestyle looks markedly different to the NHS of stripy pyjamas and wrought-iron bedsteads that featured in the opening ceremony of the London 2012 Olympics. While it’s a political nightmare to close a poorly performing stroke service, it is relatively easy to cut stop-smoking services, which attract less public attention, and that’s exactly what’s happened. |
| Second is our reluctance as a society to confront the costs of ageing. We can’t seem to get past the simplistic idea that there’s a generation of baby boomers who have done brilliantly at the expense of young people and it’s up to them to stump up the costs of an ageing society. | Second is our reluctance as a society to confront the costs of ageing. We can’t seem to get past the simplistic idea that there’s a generation of baby boomers who have done brilliantly at the expense of young people and it’s up to them to stump up the costs of an ageing society. |
| There is of course truth in that. But the NHS embodies not just the principle that the affluent pay more than the poor through their taxes, but that the sick don’t pay more than the healthy. That form of social solidarity is just as important, and while it may be alive and well in the NHS, it’s glaringly absent from social care. If you’re unlucky enough to get cancer, you are covered by the NHS. Get dementia, however, and those with modest assets are on their own until they have spent much of their savings; even then, cuts to local authority budgets, out of which social care is paid, mean it’s increasingly hard to get state help. | There is of course truth in that. But the NHS embodies not just the principle that the affluent pay more than the poor through their taxes, but that the sick don’t pay more than the healthy. That form of social solidarity is just as important, and while it may be alive and well in the NHS, it’s glaringly absent from social care. If you’re unlucky enough to get cancer, you are covered by the NHS. Get dementia, however, and those with modest assets are on their own until they have spent much of their savings; even then, cuts to local authority budgets, out of which social care is paid, mean it’s increasingly hard to get state help. |
| The coalition government’s response was financial sorcery: the wheeze it dreamed up was a state-funded cap on care costs coupled with private insurance to help people fund care up to the cap. But on realising this couldn’t magic away the need for more public funding, this government has kicked it into the long grass.We will have to wait until the autumn to learn about any new plans. | The coalition government’s response was financial sorcery: the wheeze it dreamed up was a state-funded cap on care costs coupled with private insurance to help people fund care up to the cap. But on realising this couldn’t magic away the need for more public funding, this government has kicked it into the long grass.We will have to wait until the autumn to learn about any new plans. |
| Meanwhile, the right answer is staring us in the face, and it lies in the NHS. We shouldn’t be expecting baby boomers to meet costs individually, but asking more affluent retirees to pay for the social care system through progressive taxation, in a way that covers those not fortunate enough to be sitting on million-pound houses. If anything, the universal principle makes even more sense for social care than the NHS. People will always be reluctant to spend money on care: we don’t save enough to enjoy the healthy periods of our retirement, let alone for the miserable prospect of needing expensive support in the years before death. And so long as it remains free at the point of delivery, this will always put undue pressure on the NHS as people spend too little on private care services and end up requiring more expensive care on a hospital ward instead. | Meanwhile, the right answer is staring us in the face, and it lies in the NHS. We shouldn’t be expecting baby boomers to meet costs individually, but asking more affluent retirees to pay for the social care system through progressive taxation, in a way that covers those not fortunate enough to be sitting on million-pound houses. If anything, the universal principle makes even more sense for social care than the NHS. People will always be reluctant to spend money on care: we don’t save enough to enjoy the healthy periods of our retirement, let alone for the miserable prospect of needing expensive support in the years before death. And so long as it remains free at the point of delivery, this will always put undue pressure on the NHS as people spend too little on private care services and end up requiring more expensive care on a hospital ward instead. |
| Those who argue we can’t keep spending more on healthcare never seem to have an answer to the following: would you ration care for older people? How would you feel if it were your 85-year-old mother denied a pain-relieving operation because she’s not got long left? Lengthening lifespans are the product of amazing scientific progress. But until we find a cure-all elixir, they carry a price tag. | Those who argue we can’t keep spending more on healthcare never seem to have an answer to the following: would you ration care for older people? How would you feel if it were your 85-year-old mother denied a pain-relieving operation because she’s not got long left? Lengthening lifespans are the product of amazing scientific progress. But until we find a cure-all elixir, they carry a price tag. |
| If we’re not willing to pay for it, the NHS will get increasingly run into the ground. The cancelled operations and arbitrary rationing will get worse. And private healthcare, which at the moment only one in 10 have, will start to look more appealing to those who can afford it. The NHS’s greatest strength – its universalism – will be at risk of unravelling. | If we’re not willing to pay for it, the NHS will get increasingly run into the ground. The cancelled operations and arbitrary rationing will get worse. And private healthcare, which at the moment only one in 10 have, will start to look more appealing to those who can afford it. The NHS’s greatest strength – its universalism – will be at risk of unravelling. |
| It doesn’t have to be like this. The NHS is popular enough that the public will pay higher taxes for it, and more than the temporary sticking plaster that Theresa May has grudgingly handed over. There’s no better way of celebrating the NHS’s 70th birthday than by joining up the NHS and social care budgets, and extending the NHS’s free-to-all principle to social care: a gift that would protect the NHS and make Britain a more decent place to grow old. This is the 21st century Bevanite solution we desperately need. | It doesn’t have to be like this. The NHS is popular enough that the public will pay higher taxes for it, and more than the temporary sticking plaster that Theresa May has grudgingly handed over. There’s no better way of celebrating the NHS’s 70th birthday than by joining up the NHS and social care budgets, and extending the NHS’s free-to-all principle to social care: a gift that would protect the NHS and make Britain a more decent place to grow old. This is the 21st century Bevanite solution we desperately need. |
| • Sonia Sodha is chief leader writer at the Observer | • Sonia Sodha is chief leader writer at the Observer |
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