David Cameron: The NHS is ‘the embodiment of fairness’
The problem with incarnational politics is that it invariably forges oxymoronic concepts by the fusion of apparently contradictory philosophies or disparate and divergent characteristics through mutually-exclusive entities.
Or perhaps that is just the postmodern condition.
The NHS is both admired and derided, despised and envied, lauded and cursed. It is politic at the moment to consider it a monument to enlightenment, the epitome of welfare provision, or, as David Cameron says, ‘the embodiment of fairness’.
Except it is nothing of the sort.
It may aspire to be, and, to be sure, there many thousands of outstanding healthcare professionals dedicated to its cause in the service of the nation’s health. One can celebrate its achievements and glory in its excellence without being blind to its inefficiencies or ignorant of its failures. For those ‘stake-holders’ who have been driven to seroxat while contending against its labyrinthine bureaucracy, who have witnessed first-hand its arbitrary rationing or even died while queuing for an operation, it is not remotely ‘fair’.
It may be fairer in Kensington & Chelsea, leafy Buckinghamshire, Royal Berkshire or rural Oxfordshire. And ‘fairness’ may be the genuine experience of hundreds of thousands of the sick and dying in the affluent shires of England. But go to Liverpool, or to Birmingham, or to any one of the 20 NHS Trusts which are deemed to be deficient in their management and offer poor quality patient services, and ask those who are doomed to use these services if their healthcare is ‘the embodiment of fairness’. Ask them about their cancelled operations for ‘non-clinical reasons’, or the thousands of cancelled appointments for suspected cancer sufferers or accident and emergency treatment because of a £13 billion computer system failure.
They are all likely to tell you where you can stick your question.
If they have lived to tell you.
The National Health Service does not inspire confidence: however much faith people may have in individual doctors, nurses or carers, the system is dogged by inadequacies and failures of co-ordination which only exacerbate the distress and anxiety already caused by illness. No one takes responsibility because no one appears to know where responsibility lies and, crucially, no one seems able to diagnose the systemic failures in order that they might be rectified for an individual patient. Even the most persistent patient with a determined GP will find it hard to discover a clear path through the labyrinth which is 21st-century patient care in the NHS.
Today, the Conservatives announce that the solution is to invest billions of pounds in the poorer areas in order to bring them to the standard of the best-performing trusts. It sounds right, it sounds good, it sounds ‘fair’, even though it is likely to mean the diverting of ‘ring-fenced’ funds from those areas of the English Health Service which are performing well, for there is not a magic pot of gold in the middle of an economic crisis which may be poured into the areas of deprivation.
But money is not the answer. If it were, every school would be like Eton, for the spending on every pupil in a state education system fast approaches that spent in the private sector. How is it that private health insurance is a whole lot cheaper than the health contribution of one’s National Insurance premium? Money does not change a careless doctor or an indifferent nurse into a good one any more than it can make a bad teacher an inspirational one. Money is not the prime motivator of those in health or education, for they are vocations. The true professional will value teamwork and a clear, sensible and supportive system for delivery and accountability to improve motivation and results all round.
Like education, the NHS is now bound by bureaucracy and oppressed by targets which are distracting in their complexity and depressing in their ubiquity. When league tables became more important than patient care, the core purpose of the NHS shifted and its primary focus became that of seeming: it did not matter if the patient was diagnosed properly or treated adequately; it was more important that he or she was seen within 30 minutes and the statistical box was ticked.
Lord Lawson once observed that the NHS is the closest thing the English have to a religion. And the peculiar thing about the NHS is that it is now exclusively English: Scotland runs its own health affairs, as does Wales and Northern Ireland. So when David Cameron talks of the National Health Service he means the English one, for in the post-devolution settlement that is all that the Conservative Party may now legislate to improve.
But this improvement will not come with money: like all universal religions and socialised bureacracies, it is crying out for reform. The NHS has become more sacred than the cow, more halal than thabia, more kosher than kugel. It has an infallible priesthood propagating unquestionable precepts, and David Cameron has to prove his doctrinal purity and theological orthodoxy by venerating the bones of Bevin. But the system’s corrupt indulgences and waiting-list purgatory can only be addressed with the boldness of a reformer who is prepared to advocate the priesthood of patients and nail his diagnoses to the door of Number 10.
But that, of course, is heresy.
And Cranmer knows only too well what fate befalls the heretic.