We need to be realistic about the NHS

There is an excellent letter in the New Scientist on the matter of the NHS.

UK voters will be bored to tears by now of the constant promises made by all parties about the level of spending on NHS. They might also have noticed the utter lack of conversation about the scope of the NHS, and exactly what it should be. This matters.

The letter, from Christopher Burke, points out that when Nye Bevan introduced the NHS in 1948 for everything “cradle to grave” to be free at the point of need, “everything” was not very much. There was a general culture of self-reliance in the UK (no one went to A&E with a hangover or a sprain), and “little appetite for prolonging life for the sake of it”.

So it just didn’t cost that much – a tax rise covered the lot. That’s not the case any more. There has been a explosion of hugely expensive diagnostic tests and treatments, and new expectation that life will be extended at all costs, a huge increase in life expectancy and a nasty rise in lifestyle related illnesses (think type 2 diabetes and the like).

The result is that no tax rise can possibly cover the bill –  £8bn here, £10bn there – it just isn’t enough.

That means that we need to replace the original idea of everything from cradle to grave with a clear definition of what the NHS will and will not do. That won’t be easy: “the required alteration in public expectations will be as radical as the introduction of the NHS itself was in its time”.

But if we want to hang on to the core of the NHS, there isn’t a choice. We have to stop talking about the cost of the NHS as it is and start talking about the scope of what we can actually afford.