Radio Four’s Analysis came back for a new series last week, starting with an excellent programme on the NHS reforms called Unhealthy Expectations. Excellent because it made the only point about these wretched reforms worth making, which is that they are about as relevant to the real problems confronting the health service as is the test match score to the state of the British economy. Its unarguable thesis was that the health reforms miss the point entirely that our expectations from the health system are running farther and farther ahead of our capacity to pay for them.
The programme unearthed all sorts of apocalyptic predictions. Sir John Oldham, he who enjoys the wonderfully Stalinistic title within the Department of Health of National Clinical Lead for Quality and Productivity, was alarmingly precise in telling us (twice in fact) that the number of people with chronic conditions will be up by 252% by 2050, while John Appleby, chief economist of the King’s Fund, contented himself in looking forward to the day, 50 years hence, when Britain will be spending a third of its GDP on healthcare. But it was Sir John rather than Professor John who had the real peach to put on display. By 2065, he claimed, on current trends, the USA will be spending its entire national wealth on health; bad news, it seems, for those of us hoping that there might still be some capacity left by then for making further episodes of The Wire.
There was consensus among the talking heads that the only way back from this dilemma is to get a proper grip over the management of long-term conditions, which already account for 70% of what we spend on healthcare. Oldham argues that unless we tackle this “tsunami of need” then the NHS will become unsustainable. In a recent article in the Guardian he laid out his prescription in more detail, arguing for a kind of patient DIY approach to chronic care that makes you wonder why David Cameron hasn’t already signed him up as an exemplar of the Big Society.
Oldham’s overt comparison with care in the community for the mentally ill will raise a few eyebrows, not least over in the newsroom of the Daily Mail that was once fond of equating this policy with demented psychopaths knifing passers-by. More sanguine voices will point out, as did John Appleby, that a proper policy of care in the community costs more money to implement, not less, though that observation may be peculiar to the circumstances of mental illness.
I enjoyed too the floundering attempts of programme presenter Michael Blastland to get to grips with emerging opposition health policy, via an Oxford academic Marc Stears. Stears is associated with the rise of what is becoming known as “blue Labour” (the “blue” incidentally is a reference to blue collar – this is stuff for the workers we are talking about – not stealing Tory policies; Blair has already done that).
Stears was big on something called “relational welfare”. This, he said, means that “the focus has to be on the patient and on the professional judgement of the person providing the service”. The doctor-patient relationship may be Labour’s next big idea for healthcare, though it may take somebody less erudite than the IPPR or University College, Oxford to point out to them that it doesn’t sound terribly novel.
Confronted with the question of what relational welfare might mean to an actual worker sitting across the surgery from his doctor, you could tell that Stears was struggling to convince Blastland that he knew what he was talking about. Or himself for that matter.
Politicians were largely absent from the Analysis programme, though there was the occasional velvet rustle of Stephen Dorrell, still prowling in the wings as Lansley dies on stage. This left the way clear for Howard Glennerster of the LSE to accuse them of ducking the big issue of how are we ever going to pay for all this healthcare and to argue (using recent pension reform as an example) that the British people can be relied upon to be much more mature about all this than we might expect. The Government has established a commission on the funding of long-term care, the programme asked, so why not for healthcare as well?
As I pondered all this, news broke of the prime minister’s latest speech on the health service, the one in which he set out his “five guarantees” for the future of the NHS. Leaving aside the observation that the Government’s idea of a manufacturing-led recovery seems to consist entirely of writing speeches for David Cameron on health, one is left to survey these guarantees with a deja vu mixture of frustration and gloom. More money will be spent. Waiting times will be kept low. The NHS will not be privatised. These are the usual boilerplate pledges that politicians have been repeating about the NHS for years and years, and look where they have got us.
Of course, these are platitudes that Mr Cameron has to repeat, to settle the public’s nerves about the reforms, and his own about their poisonous impact on his political reputation. So, once we had got beyond these sugary statements we can find the meat of his address, the part where he asks the public to face up to the hard truths about the runaway cost of health care and to accept that the need for reform is a symptom of the problem, not the problem itself. Well, no actually