Why is the NHS still so important to the British?
As Ed Miliband unveils his plan at this years Labour Party Conference to introduce a mansion tax to help ‘save the NHS’, I am led to ask the question “Why is the NHS still so important to the British people?” I believe that the question can be answered by considering what the NHS is and what the NHS does, but that it is even more revealing to look below the surface and to consider the enduring values that the NHS continues to represent.
The importance of the NHS can be linked to three central pillars; funding, staffing, and control, each of which continues to receive attention from politicians and policy makers alike. In relation to the first of these – funding, the dogmatic resistance of the British electorate to insurance based funding systems (National Insurance contributions being no more than a token gesture to the concept of a hypothecated tax) has enabled politicians to still credibly claim that the NHS provides care ‘free at the point of need’. This in itself is no minor achievement in itself, particularly at a time where the concept of universal benefits appears to be under threat. It is somewhat ironic that prior to the Miliband speech, Ed Balls as Shadow Chancellor donned his sackcloth to justify proposed reductions in universal child benefit.
The second pillar of the NHS – staffing, is based around the enduring caricature of the healthcare professional as the altruistic ‘angel with the lamp’ and is less straightforward to assess. The health workforce in the UK now accounts for close to a third of all public sector employment, which must in part account for the still widely held belief that despite the GPs as small businesses, the privatisation of health infrastructure and increasing encroachment of private management, the NHS is still recognised to be a nationally funded and delivered service. In fact the idea of the NHS as a public service has never been capable of surviving more than superficial scrutiny. As its original political instigator in 1948, Nye Bevan was all too well aware that he would not have succeeded in bringing together a disparate and shambolic set of services were it not for the concession of allowing doctors to remain as small businesses of for their surgical colleagues to keep their private practices in the newly nationalised hospitals.
Finally, one cannot underestimate how reassuring the existence of the third pillar – control, is to a public that wants to believe that the state is able and willing to consider their needs rather than finding themselves at the mercy of those nebulas but powerful ‘market forces’. So while everyone loves an entrepreneur – the Richard Branson’s of this world and we are all too ready to embrace the latest consumerist temptations in the form of a new piece of wearable technology from Apple we appear to remain fundamentally suspicious of the underlying motivations of market based healthcare.
Yet the challenge and the opportunity at the heart of the NHS relates not just to delivery structures, management systems or even funding arrangements. No, what makes the NHS unique even by comparison with other countries public health services are the values that underpin it; values that focus on collectivism, welfare and universalism. It is these values that combine to create the basis of an incredibly powerful brand loyalty, a loyalty that multinationals could only dream of but which is all too often underplayed for fear of sounding old fashioned or ‘off message’.
So, as the pillars holding up the NHS become subject to increasing wear and tear, one is left to reflect on what the Labour Party should do with the taxes drawn from the soft underbelly of Britain’s property elite. The answer is likely to be to throw money at it and then to reposition the deckchairs. The approach worked for the Blair Government and to do more would require not only a more fundamental questioning of how much the British public are willing and able to pay for their NHS, but it would also require revisiting the founding values that helped to create one of the last great edifices of post war social democratic renewal. At a time of continuing free market hegemony is Ed prepared or willing to consider such an undertaking? Yet if he did then not only would he get an answer to the question as to why the NHS is still so important, but he may also have a values base upon which to shape policies that ensures its value remains enduring.