Medicine
Rationing the NHS
John Linklater
We heard, last week, that the Government had decided to stop pouring more and more money and resources into health care. The annual cost of the NHS now soaring, faster than inflation, past the £3,000 million mark confirms to us the truth of Mr Enoch Powell's warning of ten years ago that, so long as the NHS remained free at the time of use, the demand would always increase to absorb all the resources available. In the absence of the natural deterrent of payment for service, these results are predictable.
Another, equally valid, reason for the inevitable rise in the cost of any health service is that, as medical know-how and technology improve, so treatment becomes more expensive. A single complex operation nowadays can occupy a surgeon with three or four assistants,. an anaethetist and a large number of nursing and technical staff for a whole day, while our ever increasing battery of more and more specific drugs in more sophisticated formulations, adds considerably to the total bill. On top of all this we have to face the cost of the oppressive Parkinsonian growth of the NHS administration.
When the NHS was introduced, nearly thirty years ago, we were assured that the high cost of about .E150 million — as it then was — would rapidly be reduced as soon as the postulated backlog of untreated cases had been disposed of. But the backlog was a political myth, and figment of an imagination based on some atavistic concept of thousands of poverty stricken patients waiting outside hospital gates, unable to afford treatment. We now appear to have replaced that myth with an equally unrealistic, politically linked dogma that all health care must be 'free,' especially if it is only marginally related to health, as with contraception and abortion for convenience.
Successive governments, facing these problems, coupled with the problem of a growing shortage of doctors due to immigration, realised that they would either have to raise medical salaries by about 300 per cent or adulterate the service by diluting it with less well qualified doctors from overseas. They chose the cheaper course, and brought pressure upon the General Medical Council to register, with_ out question, men who could never have qualified as doctors from one of our own medical schools. This situation continued until the Merrison Committee finally and officially exposed the fraud, and doctors wishing to practice in this country will henceforth have to be examined both in English and in medical competence.
The immediate result will be a great reduction in the available number of junior hospital doctors, and this will be followed by a reduction in the number of senior, specialist consultants, of whom many are likely to go to European countries as soon as the EEC machinery is negotiated. It would of course be possible to raise salaries to an acceptable level, thus putting an end to losses by emigration, and to recoup the cost of so doing by imposing a standard consultation charge, at general practitioner level, for the first consultation in any illness. This would also reduce the total demand on the NHS but it is very doubtful if any Labour government could so obviously slay the sacred cow of "free" health, however cogent and compelling the reasons.
What this country urgently needs, in fact, is to take the NHS out of the realm of party politics altogether, by setting up an independent, inter-party committee of' inquiry, somewhat like the Merrison Committee, to report on the whole question of the financing of the NHS.
The commonsense solution of an independent inquiry into NHS finance is unlikely to prevail against embittered Tolpuddleology, and we shall therefore almost certainly be faced with the only possible alternative solution, in the form of health care rationing, by allocation of priorities. Barbara Castle has, indeed, already written to Mr Lewin, Chairman of the Council of the British Medical Association (BMA), inviting his co-operation in choosing the right priorities. By throwing this unpalatable pill into the BMA plate, Mrs Castle no doubt hopes to be able to blame the doctors when she has to announce some unpopular cuts in the service.
The allocation of priorities is, and must remain, a government responsibility. The doctor's duty is to give his patient the best treatment that is available. It is for the Government to state unequivocally how much treatment it is prepared' to pay for.
In the end, the first economy will be the hardest to make. Namely, to, cut down on the vast and costly bureaucratic tophamper. It is quite absurdly wasteful that there should have to be more than one full time member of administrative staff to control the activities of each doctor. The next economy decision will be between men and buildings. Speaking as a potential patient, I would far rather be looked after by a first-class doctor in an antedilu vian ward on a rusty bed, than by an untrained goon in the finest. hospital building in the world. If she holds these priorities in mind, Barbara Castle may yet succeed in keeping the NHS ticking over without dipping further into the national purse.
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