Political commentary
Listen to Miss Marple
Colin Welch
It is absurd to say that the Government wants to destroy the National Health Service when they are spending £14.5 billion on it, an increase of five per cent in real terms since coming to office. This line of self-exculpatory reasoning, deployed by Mr Fowler in the House and by Mrs Thatcher at times, wholly convinces neither Mrs Dunwoody nor me. I wonder what shrewd old Miss Marple would have made of it?
`Ah, my dear, but they weren't paying old Lady Beveridge all that money because they were fond of her. Oh, dear me, no do you prefer China or Indian? — they paid because they had to and couldn't think of any way out of it. And it was more and more every year. This money was not a tribute of love. On the contrary, it was one of the main reasons' — and here Miss Marple's voice dropped to a whisper — why they wanted her out of the way.'
That there is something rotten in the state of the NHS is apparent to all. I sought enlightenment from the Commons debate on the subject and got some, albeit oblique- ly, in ways unintended by those offering it.
Let us suppose for a moment that Mrs Dunwoody's rantings are correct in substance: that care of the nation's health is entrusted to villains like Mrs Thatcher and Mr Fowler who, by reason of their lack of heart and compassion, their lack of mental- ly handicapped children and chronically sick relatives, are spectacularly unfit for the task. Well, who put these wicked people in a position where they can reduce the health workers to beggary, steal the patients' meals and sling the sick helpless out onto the streets? Who but the voters in the first place, to be sure; and who else but Aneurin Bevan of holy memory, whose name was of course ritually invoked? The powers now misused by the wicked are those which he arrogated to himself and bequeathed in- advertently to them.
Health is too important, one socialist averred, to be left to the 'vagaries' of the market place. Very well: it is now instead ground between the upper and nether vagaries of politicians on top and pickets underneath. Like it or not, `vous l'avez voulu, Gwyneth Dunwoody'.
At one point Miss Jill Knight, in manner and sentiment not unlike the best sort of staff nurse, was being rudely heckled by boors opposite, Celtic or Rangers sup- porters you might guess from their rough Boeotian objurgations. If they really regard clean hospitals and authoritative matrons as undesirable, as they seemed to do, and doc- tors intimidated by bullies as matter for mirth; and if they truly represent the party that cares, and think themselves fit to look after the nation's health: well then, I thought, as Miss Knight said, no one is safe. Heaven help us. Of direct enlightenment, of any sign that anyone at Westminster has any idea of what's wrong and how to put it right, I got none. Perhaps I was unlucky.
The beginning of wisdom in this field is surely to mark, digest and profit from Beveridge's huge initial mistake. He thought that once the NHS had dealt with the horrendous backlog of the past, clapped specs on every nose, a wig on every pate, teeth in every vacant mouth, a truss on every hernia and so on, it would get cheaper. But alas, no. Medical science is in a state of explosive growth. The greater our command of it, the greater the expense. An ailment for which a Victorian doctor would have dished out a 3d bottle of jollop may now legitimately call for tests and treatments lasting months and costing thousands of pounds. This is at root why the NHS needs more and more money every year. There is no reason in medical science itself why the whole national in- come and more besides should not be spent on medical care. A problem indeed.
Somewhere well short of this absurd point a line must be drawn by someone: we have to eat too, after all. Who is to draw it? The private patient paying his own bills draws it for himself: 'Enough — I can't af- `My old man keeps saying he fought in the war for people like me.' ford any more.' Where the state pays the bill, it draws the line for all of us willy-nilly; without regard to our individual wants and needs: no more of this treatment or that, r10 more kidney machines, no more pay for these workers or those, this hospital closed, no more meals in any hospital, these Pa' tients discharged ill or well, these opera' tions or those postponed indefinitely or for ever, arbitrary 'efficiency savings' demand" ed, as Mr Fowler has recently done. By the Left 'efficiency savings' are deplored — and not wholly wronglY — as just a euphemism for cuts in services to Pa: tients. As the North East Thames Health Authority has put it, 'in an ideal world the efficiency savings requirement of the Treasury/DHSS would be based on hot' factual evidence of inefficiency. It is not.' If Graham Turner's researches, recently published in the Daily Telegraph, are any guide, such 'hard factual evidence' w°111,i be as difficult to find as De Lorean ,7s millions. He asked, who runs the hospitals. Answer got he none. There opened before his eyes certainly no 'ideal world' but rather a chaotic vision of don't knows and don t cares, as also of good people reduced IV idiotic paperwork and bureaucratic P0)- crastination to blank despair. His sources, were horses' mouths, his impressions °I 'substantial waste and gross inefficiencY% of squalor combined 'with a certain pro- fligacy'. It sounds like the sort of Aug mess in which 'hard factual evidence', aPoll from what is turned up by outside ill' vestigators like Mr Turner, is more likely to be suppressed, buried or lost than prodoc,, ed, analysed and used for reform. Nor is 1,,` only inefficiency which renders the N14,' cost-blind. It is also a basic philosoPild which encourages patients to demand all doctors to supply benefits regardless of cost. The Government tries to clap on the brakes. It is not easy: like trying to arrest a lava flow, an avalanche or a stampede. The NHS administration may render the brakes ineffective or, worse, slew them to operate with hideous unfairness, causing great hardship to the sick while leaollb numberless paper-pushers and abuses t disturbed. The Oxford region has villiPs and scorpions for its patients but not, so far as I can see, for its own swollen staff' , Jobs are thus preserved, and public angeA' diverted on to a seemingly mean all.! heartless government. The Government I? also locked in an unedifying national dispute with the health workers, for s°11.1 of whom there is sympathy. And Mall must deplore the involvement of the flai tional Government in what were surely best settled locally and differentially, according to local needs and resources. If you are with me so far, you maY Yet wonder what alternative there is to the NHS. I hope soon to examine alternatives, one unfamiliar and to me promising. 'Of course there was a way out all the time", Miss Marple sighed. 'Why are Peo- ple so blinkered?'
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