ANOTHER VOICE
A further villainous sigh from Tom O'Bedlam
AUBERON WAUGH
Ihave a friend who works in the Bethlem Royal Hospital, now situated in Monks Orchard, near Beckenham — the same institution which was popularly known as Bedlam when it stood in Bishopsgate, from the 13th to 17th centuries. It became London's most famous lunatic asylum — to such an extent that by the 18th century, when it had moved to Moorfields, it was one of the sights of London. Parents would take their children of a Sunday morning to watch the mental patients loping around in its spacious gardens, or gibbering at them from behind bars.
Times have changed, of course. The lopers have now been turned out into the cold — euphemistically called 'community care' — and are to be seen loping in disconsolate little crocodiles over Rams- gate Sands and most areas of the South Coast. The gibberers are now shut indoors and stunned by four-hourly medication. They no longer provide the material for a homily on the perils of drink, or masturba- tion, or whatever.
Many is the evening that this friend and I have tired the sun with talking and sent him down the sky as I explained my theory that no matter how much extra money the government allocates to the Health Ser- vice, we have reached such a state now that it will always be grabbed by NHS em- ployees long before it reaches the patient; and that with the rising tide of NHS employees' expectations, it seems likely that they will grab even more money than the government allocates, making up the difference by reducing services to the public — hence the closure of beds, wards and whole hospitals, the shortage of drugs and equipment.
It strikes me that there may have been an element of smugness in my friend's decision to send me a copy of last week's Marplan survey, published in the Health Service Journal for 15 May, which suggests that 72 per cent of the population — nearly three out of every four citizens — believe that the current level of spending on the NHS is too low. However, I do not see that this information contradicts anything I have ever said. All it proves is that too few people read the Spectator. Everybody else has been gulled into accepting the simple proposition that the more money that is spent, the better the service will be. There is certainly no shortage of highly qualified medical and administrative opinion to assure them that this is the case. What annoys me slightly is the way that specialist writers in the secular press toe the official DHSS line when all the facts and figures are available for them to see what is really happening.
On Sunday we read that nurses' pay is to increase by ten per cent, something of which nearly everyone in the country will approve (although I treasure the thought of Marplan's three per cent who think that the current level of spending on the NHS is too high). We all like nurses, and there is a general feeling in the country that if you like something, and it moves, the govern- ment should give it some money. This increase, which is three times the current rate of inflation and much higher than the already high average of settlements, will be represented as an increase in government expenditure on health (as, in real terms, it is).
How will it improve the level of medical care? Everybody agrees that nurses are a special case. They are always a special case, despite having been allocated a 5.5 per cent increase last year, taken rather more, reduced their working hours from 40 hours to 371/2 hours a week and made up the difference (in Newcastle, for instance) by closing down 80 orthopaedic and surgic- al beds.
Newcastle and Manchester were made the subjects of special study this week in the Observer and Sunday Times respective- ly. Whereas expenditure on the Health Service has increased by 24 per cent nationally since the Conservatives came to power, in both Newcastle and Manchester it has increased by far, far more, as a result of government policy to take resources away from London and give them to these northern areas.
The North Western Regional Authority, for instance, which covers Manchester, spent £380m in 1978, the last year of Labour Government. This year it is spend- ing £908 million. Yet Manchester can not only show growing waiting lists but also, despite a significant increase in staff (to cover the shorter working hours) hospital wards closed for months at a time.
Specialist journalists who rely on these health authorities for their information may or may not feel inhibited from dis- agreeing with their informants when it comes to interpreting what has been hap- pening. Or perhaps it is just good manners which prevents them from querying the explanation they are given. At any rate, here are the explanations offered for what has now at last been identified as a phenomenon of our times, that while spending on health rises — sometimes, as in Manchester and Newcastle, quite dra- matically — the standard of health care demonstrably declines.
The Sunday Times proposes two ex- planations: our aging population requires one per cent more medical attention per annum; the government's 'value for money' campaign (not to be confused with Mrs Thatcher's non-existent government cuts) is 'cutting the service to the bone'. The second explanation is plainly rubbish, and I doubt the truth of the first. Even if it is true, it does not begin to explain what has happened to all the extra money. The Observer places the blame fair and square on the growing private sector in medicine: it takes away valuable resources from the NHS and, by catering for influen- tial people, prevents NHS shortcomings from being exposed. This attempt to politi- cise a matter which should, surely, be of some concern to everyone in the field results in the most glorious piffle.
But I am still irritated by the way so few people can see what is going on. Surely the journalists should try a little harder. For three years I have been pointing out exactly what has been happening in the Health Service, and that it is really very simple indeed. We can see the end result In closed wards and lengthening queues; all we needed was the figures for the increase of government expenditure in real terms, area by area. These are now available.
The Newcastle and Manchester experi- ences do no more than prove the Gammon Law of Bureaucratic Displacement, that 'in a bureaucratic system . . . increase of expenditure will be matched by fall in production'. It seems harsh that those northern regions most in need of help should be hardest hit by the application of Gammon's Law. If public opinion takes two years to catch up with the facts as theY are presented in the newspapers, and the newspapers take two years to catch up with Spectator, we can be sure that as the Health Service declines there will be loud- er and louder cries for more money to be, spent on it. Only the collapse of the pouna, and the great Hattersley Bankruptcy of 1987-8 can save us.
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