Politicians’ promises of growth are illusory: they will soon have to make hard choices about what is worth paying for
Matthew Parris The Times 13 August 2022
Gerry Gajadharsingh writes:
“I have posted over 250 blogs over the past few years and have tended to stay with health-related matters. I couldn’t resist posting the blog below, recognising that there is perhaps a danger that I’m straying into politics, but I couldn’t help myself, as there is an important health message coming out of the article.
This message has been a long time coming, it’s the first article that I have seen, spelling out in black-and-white, calling for a rational debate on the services that we think are essential, well done to Matthew Parris for raising the issue, which a number of commentators have raised over the past week. While some may have a partisan political agenda, our population and politicians do need to have an honest debate about what taxpayers’ money should be used for, how much should or can be funded by taxation and which services are, in this context, ‘essential’. In an ideal world, where money is not a problem, the so called “rich” countries could potentially fund anything that their population wishes, as long as the majority agree. But no-one lives in that ideal world Since the financial crash of 2008/2009, we seem to be living in increasingly uncertain times, with disaster after disaster, leading us to the point where we are now, with many individuals and businesses struggling financially and governments running out of room to simply keep on printing or borrowing money.
Many people feel that the country seems to be falling apart. Issues such as the NHS, climate change, police and crime, social care, transport, the war in Ukraine, energy prices and inflation crowd in as our country faces, inflation at a 40 year high, the highest tax burden for 70 years, government debt at a record high, and the financial resilience of many individuals and businesses is at a record low. This makes for generational financial inequality and increasing division between the haves and have nots. And so. it is an awkward but necessary time to have a difficult debate about how and what money is spent.
Parris says “Buses are only one item on a lengthening list that will take centre-stage in the politics of the next decade. It’s the list on which, in an age of gentle contraction and relative economic decline, we divide publicly funded benefits into “essential” or “inessential” services. It’s an impossible task, very subjective, but it will have to be attempted.” I agree.
Pressure groups become very adept at raising specific issues with the general media and social media upping the tempo until politicians, cave into the pressure to fund something. Every new thing that is funded is obviously great for that particular pressure group, but at what cost to wider society, – where is the coherent strategy following rational debate?
Parris continues “Doctors and hospitals? Essential, but shouldn’t those of us who can afford it pay something beyond our taxes for what we actually use? Cancer patients wait months for hospital treatment, so why shouldn’t I — why can’t I? — pay for the small, desirable but inessential operation on a hernia that bothers but does not kill men of my age? Ditto visits to the doctor.”
Taking Parris’s idea of separating ‘essential’ from other services and looking at who should pay for which, raises stark and uncomfortable questions when we look at the NHS. How should we fund it? What should it provide? Governments and various committees have tried for numerous years to do something about this problem but the current state of affairs suggests that they have failed (and we can’t just keep on blaming it on Covid). Medical innovation is wonderful but also incredibly expensive, – new cancer drugs are examples. Medicine can now do things we could only dream of 30 or 40 years ago, but this comes at a cost. We now spend £150 billion on the NHS alone (2022/2023), 12% of GDP in 2021 (in the 1980’s it was 5% of GDP in the 1950’s about 3% of GDP), it is certainly not ‘free’ although it is to users at the point of access. We have the longest ambulance waiting times, the longest A&E waiting times, 6.5 million patients waiting for NHS treatment, patients unhappy because they can’t see their GPs, GPs unhappy because they say they have too many patients to look after safely, patients with no dedicated GP affecting continuity of care, many GP’s working part time because they say full-time work is not sustainable for their own mental and physical health, 90% of dentists having closed their lists to NHS patients and the list goes on and on.
Parris suggests that “Ever since I started dealing with the leader of the opposition’s postbag in 1976, I’ve been familiar with the cry, “I haven’t worked and paid taxes all my life, only to have [insert chosen desideratum] taken away.” I longed to reply, “You may well have paid taxes all your life, but not enough, as it now turns out.”
So that’s the crux of the matter, how much are we willing to pay in taxation and for what? Given that taxation is now at its highest level for 70 years, I’m not sure how much more tax most people are able or willing to pay? Should the tax burden be redistributed? Would that raise enough?
Parris continues “Local libraries? Leisure centres? Subsidised public swimming pools? Winter fuel payments for higher-rate taxpayers? Free school meals during holidays? Advice centres? Parenthood classes? Good things, some of them, but essential? We must be jolted into asking how citizens might band together to help voluntarily or even — good heavens! — actually pay for things.”
Different people will have different views on what is essential and what trade-offs should be made . If we confine our thoughts to health, we must recognise that many people think the NHS is not fit for purpose. It does not follow that it cannot be improved but, if we are to make essential service available to those in need , what should we do? I believe that we will all need to take more individual responsibility for our health and, as I see it and Parris as well, where possible, contribute towards the cost of some healthcare, if we can afford it.
So, what do I think is essential?
I’ve always felt that we need to have a brilliant NHS accident and emergency service (not a service currently stuffed up because patients can’t get in to see their GPs and attend A&E for non A&E problems!), we need to have an NHS healthcare system that focuses on serious disease and not try and offer all things to all people – it just won’t work. Many health conditions are not life-threatening, many are functional, many are impacted by the “lifestyle” choices we make or don’t make, “stress” also has a large part to play. And as I’ve blogged many times before the devil is in the detail of what constitutes a good or not so good lifestyle and how stress affects us individually.
And I’m not just talking about the usual culprits of alcohol and tobacco but of a much wider range of issues. This is uncomfortable for many people as they will often associate the message as one of “blame” and we shouldn’t blame patients for the illnesses that they have. But this is not about ‘blame’ but encouraging people to take responsibility and, in some cases, paying for healthcare if and when we are able to. do so. This reduces the pressure on the NHS and therefore the taxpayer and perhaps it is only then that the NHS can actually concentrate on the things that it is good at and provide a service that is acceptable to the majority of our population and meets the needs of individuals and. of a fair society