The National Health Service

The British National Health Service (NHS) is the greatest social advance in my 85+ years on the planet. I was in at it’s conception as I sat at a table in Brusa’s Restaurant in St Martin’s Lane, London, day after day listening to Aneurin Bevan and Michael Foot discussing how it would work. In practice, the NHS has been immensely successful in making the lives of millions happier, healthier, longer and more comfortable. It has one problem, it is too expensive.

“Free at the point of delivery” is a great aspiration but it is almost always proved to be a mistake. People generally don’t value what they get free. The idea that people get health care regardless of how poor they are is good. Before the NHS existed doctors created an informal system where the rich paid more and the poor paid less. Each, in theory, according to his or her means. It worked until the better off started demanding cheaper treatment on the grounds of equality. The truth was that the poor were at a dreadful disadvantage – and that was when medicine was relatively cheap. Today’s medicine is expensive.

From the early 1950s the British have had access to a system nobody else in the world has. No wonder so many want to live there. The NHS has been creaking for years. It has dealt with it’s overload in the only way possible. The acute are by-and-large extremely well looked after; the chronic wait, because they can, in the sense that they are less likely to die. But their waiting is often very painful as well as frequently terminal.

The British Government proposes that a new tax, dedicated exclusively to the National Health Service, be imposed. Politicians use the term ‘hypothecated’; it means the same thing. This is a bad idea. Firstly, dedicated taxes can so easily be undedicated. Secondly this one will be simply another form of income tax. More income taxes are a bad idea, the tax system is already hideously complicated. Thirdly, how do you define spending on the NHS? Is food part of it? Of course, but for who? Is exercise part of it? It is certainly a big factor in health. Every Tom, Dick and Harry will want to be financed from a dedicated health tax. This will obscure the purpose of the tax to the point where nobody is clear what it is for.

Part of the reason for the NHS excessive costs is that, being free, it is used quite excessively. Minor ailments should be dealt with by OTC medicines that require no prescription. They cost money. For most people a couple of hours visit to the doctor is no problem – and no expense. So people go with trivial problems and expect prompt and free treatment, which they get. Another problem for the NHS is waste. I have seen figures of £30BN used to define waste in the system.

Both these sources of cost would be reduced by a simple payment of a small amount, say, £5 or £10 per visit or treatment. It could even be made a more sophisticated system where certain sorts of treatment deemed largely social, for example excess alcohol intake, could be charged more. It has been said that the cost of collecting these amounts would exceed the contributions. In our digital age I don’t believe that but if it is true the amount of the payment would increase.

In a society so deeply welfare entrenched there will be hard cases to consider. It is time to reignite the concept of family responsibility and demand that they pay these trivial fees for those genuinely unable to do so themselves. The advantages of all this would be that people would appreciate their health service more. The amount of waste would be reduced by the reduction in stock carried – and often outdated – as a consequence of people not going to the doctor for cough medicine.

Politicians of all parties say this is politically unacceptable. If it is as badly sold as the Brexit referendum, I can only agree with them. If, however, a sensile educational campaign could be mounted and the main parties could agree the move in advance, the furore would be a five-day wonder. I doubt there is a politician with the guts to take this sensible step and that will leave Aneurin Bevan turning in his grave. For he was a pragmatist and he would see the move as a sensible step to ensure his beloved National Health Service continued to be the best in the world.

The series on Strategy, with a special section for those running their own (consultancy / gig) businesses will continue in the next Daily Paradox