The British have a curious relationship with one of its biggest social benefits as well as an enormous financial albatross around its neck,-the National Health Service or NHS.
The World's fourth largest employer after the Chinese Peoples' Liberation(?) Army, Indian State Railways and Walmart, the consumer of £98.7 billion in 2008/9, the NHS both delivers a service and gobbles up money (taxation) at an alarming rate, each pound diverted from doing something else.Partly as result, many other government activities including infrastructure development get less to spend than they might need. That or the opportunity for lower taxes and more spending money in peoples' pockets is lost.
(Almost) everyone knows that the NHS, while often professionally outstanding, is very poor at other times and in other places. The culture and quality of care can vary enormously within yards in a single hospital and yet any calls to change almost anything result in howls of anguish and political approbrium throughout the land. In reality Britain is almost a health service with a country attatched.
Leading politicians rave "I love the NHS". The rider "...but it needs to change........" is treated with utmost delicacy and asbestos gloves. Some of this is of course pure political hype wrapped around the message that "Honest Tone/Gord/Dave/Nick will look after you"-Note not really, really, "will share your pain". That wouldn't go down well when we are talking about health and hospitals. Another reason is that for them the NHS is indeed genuinely marvellous,- and no wonder. If Dave, Ed (any Ed), Nick or their immediate minions so much as look at the outside of a hospital (or school but that's another story) or indicate they might go there, the cleaning gangs are called in, the loos swabbed and tidied every five minutes and any possible embarrassments cleared away, sent home for the weekend or whatever it takes,- eg "But it's only Tuesday" "Never mind,- you're going home". When Tone's ticker missed a beat at Chequers one Saturday night he was in a NHS hospital double quick. Time enough though for the order to flash in all directions that he must not see or be seen by the usual weekend collection of over festive clients and their results cluttering up A&E shouting the odds at the staff and anyone else in their blurry field of view. The NHS also rightly took excellent care of the Brown and Cameron families but did and do they ever have to wait for hours late at night on hard plastic chairs for their turn to be seen? Unlikely.
When set up by Labour as part, the major part, of its "Land fit for heroes to live in" pledge at the end of World War 2, the NHS was not and probably couldn't realistically be properly costed. Right from the start there were unecessary and costly mistakes which still persist. Thanks to the party's socialist roots and ethos health care was not only deemed to be free at the point of delivery but also to be the domain of a union-pleasing monolithic state supplier which guaranteed high costs , too often indifferent quality and attitudes together with a jobs for life culture able to deliver what and how it wanted with little external challenge. Patients were also barred from making a contribution for their costs, paying for scans, tests etc even if they could and wanted to.
As result, with 1.7 million employees, any unwanted challenge, talk of change, achieving greater efficiency, greater private sector participation is greeted by a storm of invective from all quarters. Any implication that some results may be poor, some staff attitudes abysmal and in need of rooting out so as to support those who genuinely are passionate about the quality of treatment and care are greeted with a wall of hostile noise. Unions usually weigh in on the side of the noise. Sometimes they generate it from the outset. Why one wonders do they so often support the poor performers to the disadvantage of the good, many of whom are also union members? Why the support for the supply side rather than the customers, again many of whom are union members?
The coalition government started off well in being determined to wring higher performance and lower costs out of the NHS. The potential is huge. Even achieving universal cost and quality awareness would be a substantial and beneficial step forward and reduce the sound of money gurgling down the drain. The Lib Dems, as ever rather iffy in the face of the opportunity to be either liberal or democratic when the chips are down, have the wobbles about "with profit" participation and organisational or behavioural change. Labour of course are rabid at anything their union paymasters don't like and highest amongst these dislikes are things which might reduce staff=reduce union members=reduce subscriptions= give them financial pain. They therefore ramp up the emotion and "Hands off our NHS" demands at the drop of a bedpan. There is a real danger right now that the Tory side of the coalition will now go wobbly and emasculate their intended substantial changes to the service. That would not be sensible. There are still nearly 4 years to go until the next General Election so, as with the whole "cuts" programme there is plenty of time to ride out short term heat and fury from the "Do nothing" lobby of Balls and Eds various along with confused Lib Dems wringing their hands.
The new relationship of the British with the NHS should be one where the citizens are in the driving seat as they should have been all along and the howls and screams are not for no change but much more so that they aren't waiting for hours in A&Es, nor months for tests and longer for results but are getting first rate service pleasantly and professionally delivered from a first rate organisation. That should be the common and enthusiastically sought goal of all politicians,patients/customers and the best of the NHS staff. Why should any of them settle for anything less? They needn't and would be crazy to do so. They just need to understand it and be determined to get it,- now!
