In search of reform – broadening our conversation about the NHS

250,000 people marched seeking protection of the NHS from cuts, closures and privatisation.

In 1948 Britain brought to the world the NHS. It is our national treasure. It is an institution that is owned by the people it serves, young and old, rich and poor. It is an indiscriminate marvel. It is the very best of Britain in everything it is, and it is under attack.


The process of privatisation is undertaken by the unelected leader of a government that won 24% of the eligible vote. A party with no mandate and no authority are selling an institution that is not theirs to sell. They do so even as the debate drags on.


In trend with the times this discussion is superficial; it has been drawn to far-removed, binary oppositions that sit at loggerheads. One seeks reform through wholesale flogging at bargain-basement prices for the private gain of a few, the other hangs on to a creaking, dilapidated model born of a very different world some seventy years ago.


Alarm bells are ringing out across the country – the Red Cross, schooled in crises for over 150 years has declared that our health service faces a humanitarian crisis. It seems all too regularly a new story unfolds accompanied by new images and new imagery, a man found hanged in a ward, patients dying in corridors on trolleys, tented A&E wards tumbling out of hospitals, an endless stream of missed targets – they are met with a collective shrug, one after the other.


The right condemns an archaic system and rapidly changing demographics, the left point to the hammering austerity dealt by the government over the last two terms. Both claims have their virtues but are painfully shallow analyses and ultimately scapegoats for a much larger problem we must address if we are to see future generations enjoy the same privilege we have come to take for granted. It is late in the day but crucial we broaden our discussion beyond the cuts imposed by Jeremy Hunt in his search for a reduced deficit and the validation required to privatise this astonishing service that sits as the world’s fifth largest employer and treats a million people every 36 hours.


It is crucial now in the face of the existential crisis this extraordinary institution faces that we consider the context within which the NHS exists and that in which it will exist in the coming years, holistically we must search with a fine tooth comb the legitimate strains that weigh on our hospitals – to paraphrase a quote of Dr Gabor Mate; to look for the cause of this crisis in the wings, wards and surgeries of our hospitals is to search for the cause of a traffic jam in the internal combustion engine:


On average, in every minute of each day £25,000 is spent treating diabetes alone. Four million people are expected to suffer from it by 2025 – it is a condition that consumes already 10% of the annual budget.


To alleviate our Accident and Emergency departments over the weekend does not require our overworked doctors spreading their energy and resources thinner and thinner on the ground – instead we could look to the 70% of patients that on the weekend find their way to A&E units by way of alcohol related incidents. Our consumption of the drink costs up to £3.5bn per year, tobacco another five.


We must recognise too the relationship between the epidemic of depression and anxiety that sweeps the country, (a subject that is slowly, painstakingly finding its way into our consciousness) and the true costs to our society. Beyond its place as one of the most debilitating illnesses in the world, depression and anxiety are estimated to cost England alone £16.4bn a year in loss of productivity. The NHS itself spends £10bn on mental health services.


This is not to say that we are a country embroiled in sadomasochism, nor that we are selfish people or even particularly reckless. Rather we have suffered from the structures that our lives fit awkwardly around and the socio-economic conditions under which we live. There are incapacitating limits to the austerity and poverty the country suffers beyond the direct blows dealt to our services and the welfare state, the victims include our prosperity, our aspiration and health, our altruism, our dignity, our self-determination.


A third of the population fell at some point below the poverty line in the three years following Cameron’s election. Let us recognise the relationship between crushing austerity and the cost of processed, refined carbohydrates and sugars in the reduced sections of Sainsbury’s and Lidl. These are industries to which we pay 11bn a year subsidising their criminal wage packets.


Over the horizon a mammoth refugee crisis rumbles, as many as 150m people are expected to be displaced by climate change alone in the next thirty years – we do not have enough tear gas and barbed wire for them all, unemployment delivered by an industry of automation ready to explode looms around a corner not so far away, funding for new antibiotics by private institutions has plummeted, the market has recognised its futility and the ominous shadow this prospect casts over now standard procedure. We must keep these seismic entities in our sights too as we elevate the conversation of our NHS above the Commons, beyond party politics and five year terms.

To recognise these, the very real dangers posed to our health service we must expand the limits of discourse set in place, we must scrutinize with introspection everything from our antiquated education system to the real costs of government policy, from our roles in our communities to the happiness and prosperity we draw from our jobs. We must cast an eye over the farming industry and the working wage, over the crutches on which we rest and our need to do so.

Today 250,000 people marched for the future of the NHS demanding suitable funding and its protection from private hands, but as long as we maintain the zeitgeist of the day it will be for nothing. The NHS is not a static entity – the decisions we make have consequences and we responsibilities. We must be brave in our search for reform.


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