03 July 2008

What to do about the NHS?

A 60th birthday is a good time for a reappraisal - of purpose, scope, impact. Since its inception in 1944, much has changed, the challenges we face have changed and the NHS as it is just cannot meet them.

The percentage of the population over 60 is growing rapidly. The percentage of the population who are disabled is also growing. New technologies and medical advances have produced an ever increasing range, complexity and cost, of treatments which can be made available. Decades of consumerism has resulted in a mentality of 'rights' not responsibilities. There is an increasing prevalence of family breakdown, teenage pregnancy, and obesity.

The NHS as it is currently conceived just cannot meet these challenges. We need to rethink the following issues:

1. Whose responsibility are we?
The line of responsibility between state and the individual needs to move.

Elderly people are the responsiblity of their family, first and foremost. The state (aka NHS) should be involved as a support for these primary carers. It should not cast itself in the role of primary carer.

Teenage pregnancy, family breakdown, obesity - these are all the result of choices. Choices which have consequences. We need help, information, and equiping to make wise choices. We should not be protected from the consequences of our choices - or they are not really choices. We have free will, we need to take responsibility for our own life-styles.

The service offered by the NHS needs to change from 'what the NHS can do for you' to 'what the NHS can enable you to do'. The NHS has moved us from 'I need' to 'I want'. It now needs to move us to 'I can'.

2. State or society?
Government has grown rapidly since 1944 and now impinges on almost every area of our lives. Yes, we want help, information and tools to help us make better choices. But should this be provided by government? Or should it be provided by our families, friends, church, our local community?

3. National or Local?
The NHS is very good at acute care. It is not very good at care in the community. Social care and non-acute health care are two sides of the same coin - they should be combined. Let's apply the principle of subsidiarity. Specialist and acute care needs to be governed and operated at a national level. Non-specialist, non-acute community care can and should be governed and operated at a local level, combining with social care and responding to local needs, working with, and accountable to, local people.

Let the National Health Service do what it does best - acute, specialist medical treatments. Let a local health and social care service, working alongside the voluntary sector, do what it does better - caring for people in the local community.