2 MARCH 1991, Page 8


Proposals for the removal of a cancer from the body politic


0 ne of my less usefully spent evenings was recently taken up with travelling down to Brighton for a Southern Television version of Question Time, where the part of Sir Robin Day (or whoever has replaced him on the BBC) was taken by the more lissom and agreeable person of the Mir- ror's Anne Robinson. It was the prospect of seeing Anne Robinson again which tempted me, but the other panellists were Sir Geoffrey Howe, the best Prime Minis- ter we never had, G. B. Kaufman, the Manchurian candidate, and Anna Raeburn, the agony auntie or whatever. It would have been a very dull evening if Raeburn had not taken tremendous off- ence at being described by Robinson as having worked on a sex magazine — she sat seething throughout, speaking through her teeth in tight, bitter sentences — and if Sir Geoffrey had not been thrown by unmannerly heckling and by the extraordi- narily illogical contributions to the debate which came from the floor.

The first question, which I paraphrase, asked how the Government could afford such an expensive war in the Gulf when it could not afford to medicate, house, feed or educate its own citizens properly. All the other questions made roughly the same point, on the absolute assumption — un- challenged by Sir Geoffrey — that it was the Government's job to provide medicine, shelter, food and education for all its citizens. Acceptance of this point was total. G. B. Kaufman worked himself into an indignant lather about health service clo- sures, Sir Geoffrey droned on about how the Conservatives had increased expendi- ture on health by 50 per cent in real terms (as if this was something to be proud of) and Raeburn averred that she had never worked for a sex magazine. Contributions from the floor were wild, accusatory and deeply alienated from the usual disciplines of relevance or sense, reminding me rather of Virginia Utley's experiences in the jury room as told in last week's Spectator.

Miss Utley's discovery, that British juries are no longer up to the job, is one that I have been pushing for 15 years on this page, and now seems to be on the verge of general acceptance, at any rate among more reflective members of the public. In another 15 years, something may be done about it. Until then, we can only nurse it bitterly in our hearts, like the knowledge that we have never worked for a sex magazine. I have never been asked to serve on a jury, but my experience of the blank, resentful incomprehension of studio audiences to the simplest proposition in the plainest English has been enough to con- vince me that stupidity is the dominant ethos of modern Britain. Slowly, as I say, an awareness of this development is spreading throughout the country and the world. But what seems miles and miles from any degree of awareness, let alone public acceptance, is the fact that the National Health Service, through the inex- orable logic of its own aspirations, has become both a major disaster area in its own right and also a huge, malignant tumour threatening the survival of the body politic to which it is attached.

We are all aware of the heart-rending rhetoric which supports this gigantic in- stitution — almost as impressive as Richard Rogers's defence of modern architecture — and of the basic human decency which once inspired it. Although it is possible, by shuffling bits of paper around, to pretend that staff numbers have fallen in recent years to about 796,600, the truth is that the NHS provides the liveli- hood for very nearly a million employees, of whom about 770,000 are women. Its cost is due to increase by 11.6 per cent (5.2 per cent in real terms) next year or £2.6 billion to a new record of nearly £25 billion. Its apologists point out that over half of all hospital 'spending' goes on those aged over 65, who account for only 16 per cent of the population, but the truth is that only a tiny proportion of National Health 'spending' goes anywhere near the appointed benefi- ciaries. It nearly all goes on administering the great machine and looking after em- ployees, whether in terms of office equip- ment or pay and pensions, longer holidays and the rest of it.

This is the major reason why, as spend- ing on health increases inexorably, year after year, in real terms, until it threatens to take over the whole of the economy, so the actual services supplied decline, year after year, with wards and hospitals clos- ing, lunatics being thrown gibbering on the streets from their asylums, into 'commun- ity care'. The latest proposal is that pat- ients should be sent to hospitals in France for all the operations which the NHS is now unable to supply, or can supply only after a delay of several years. In France they manage these things better, with a system of partial reimbursement. The sug- gestion that the NHS should spend some of its bloated revenue on buying operations in France is an excellent one, and should be extended, but it is also an admission that our own system has failed.

The second reason for the collapse of our free health service — and the one most frequently advanced — is the catastrophic cost of new treatments. Much publicity was recently given to the case of a 52-year old cancer patient, Mrs Kendrick of Leek, Staffordshire, whose chances of survival for a further two years might have been increased by 20 per cent if she had been given a new treatment called IL-Z costing £3,000. Such temptations arise daily. A new drug against septicaemia, we are told, might save 'up to' 12,000 lives a year at a cost of only £1,000 per person. What is £12 million against an annual expenditure of £25 billion? But then, there is the comfort and security of NHS employees to be taken into account, too . . . .

Meanwhile, medical research continues. Professor David Baird excited the Royal Society last week with news of research which might save the lives of very prema- ture babies. All it required was for him to be allowed to conduct experiments on foetuses which were condemned to be aborted by the mother's wish, while they were still in the womb. 'To my mind, it would be perfectly valid to give a woman a dose of corticosteroids before termination and to look at the effects on the foetus. I do not see any ethical problems about this.'

Perhaps not. But in all the discussion about the ethics of killing we hear remark- ably little about the ethics of keeping alive. If the principle of socialised medicine is to be kept alive, I would make the following modest proposals: 1. The Government should finance no further medical research. 2. The Govern- ment should no longer pay directly for hospital or medical services. 3. Health care should be in the form of a cash payment to patients, depending on the gravity of their complaint. They could spend this on medical or surgical services, here or abroad, or on a holiday on the Costa Brava, or a new video unit, as they chose. 4. Large sums should be made available to the Hospice movement, as an alternative National Death Service. 5. Death grants should be increased for women dying under 60, men dying under 65, as a further inducement to die young. If this resulted in an epidemic of matricide and patricide in Scotland, heavy fines should be imposed.