Last Thursday, my wife was readmitted to hospital nearly two years after her first admission for treatment for acute lymphoblastic leukemia. She is very ill, but the nursing, always humane and in sufficient numbers two years ago, is reduced to a heroic but hard-pressed minimum. She has been left untended for hours at a stretch, reduced to tearful desperation at her neglect. The NHS, allegedly a “protected” public service, is beginning to show the signs of five years of real spending cumulatively not matching the growth of health need. Between 2010 and 2015, health spending grew at the slowest (0.7% a year) over a five-year period since the NHS’s foundation. As the Health Foundation observed last week, continuation of these trends is impossible: health spending must rise, funded if necessary by raising the standard rate of income tax.
The first is the overall economic point. Something that “requires” an ever growing budget in real terms, one that requires that ever growing budget to increase faster than the size of the economy itself, cannot be allowed to continue to do so. For if we do let it run on then it will swallow the entire economy at some future point. We must therefore change the way that we organise said activity. In order to raise productivity: thus we can continue to increase the amount of the good and or service that is offered while not having to increase the resources devoted to doing so.
And the only way we’ve really got of improving productivity is the use of markets. No, not the full blown American health care system, just the use of providers competing in markets, with government financing. And we do even know that this works. NHS England has had some of this for a decade or more, NHS Wales and NHS Scotland have not. And NHS England has been getting more productive more quickly than NHS Wales and or NHS Scotland. We do actually know that this works.
Good, so that’s what we must do then.
And as to the personal, yes of course it is tragic for you and your wife. And yet the two of you are multimillionaires from that buy to let empire. And further you alone are making of the order of £200k a a year (Master of an Oxbridge college, main columnist in a national newspaper? Book sales? Yup, you are). And yet you are calling that people on the minimum wage should pay more income tax in order to care for your wife in her hour of need?
Umm, no, sorry , not buying it.
You dip into your savings and hire a nursing assistant. That’s what you’re complaining about, not nursing itself, but basic care and attention. And your wife doesn’t need that at all hours of the day so the hire can help out with the other patients at times as well perhaps. You know, given that you’re one of the noblesse of our modern age, how about showing some of that oblige?
One more thing:
Equally, there was no point in holding the 40% stake in Eurostar, forecast to generate more than £700m in dividends over the next decade and a good payback for £3bn of public investment. Thus it was sold for £757m in March, the government concerned to get the sale through before the general election. You could only proclaim a £2.25bn loss on the public balance sheet and the surrender of £700m of dividends as a “fantastic deal for UK taxpayers”, as Osborne did, if you see zero value in public activity.
Or possibly if you understand the concept of discounting to net present value……