The NHS is a beloved national institution and we are all united in admiration of that simple promise of free healthcare for all. However, we too often dress up its practical purpose in the messianic garments of a national religion. Sometimes, perhaps for fear of compromising that unity, we can become blind to its faults.
For though I love it, the NHS is a sickness service rather than a health one; its own constitution says so. It exists to ‘improve, prevent, diagnose and treat physical and mental health.’ All of these things it does very well, but it seems unambitious – maybe even incomplete. There is far more to healthcare than hospitals and doctors.
What about the environmental services: sewerage, refuse, water, housing, pollution, food and nutrition policy? What about building physique and fitness, educating people about health and ensuring healthy and happy towns and cities? Where is the NHS’s ability to build facilities for mental health and leisure: tennis courts, swimming baths, parks and gardens? None of these are trusted to the NHS because the NHS is designed only to help those who are suffering, or who think they may suffer, rather than as a comprehensive system of health services.
The very organisational model of the NHS is to blame for this shortcoming, because who in their right mind would trust all those activities to one totemic and unelected organisation – or to the unelected Clinical Commissioning Groups that make these decisions? The NHS is a product of post-war socialism’s need to control. In modern times its unaccountable centralised organisation, exemplified by recent decisions over IVF funding and services, are emblematic of the sort of large, impersonal governments that people dislike.
Just as Martin Luther thought the Church had lost its way, I think the NHS has lost its. And like him, I propose a reformation of sorts. But where he tore up all that was good, I intend to follow the sturdy Anglican model; to suggest improvements in a system based on a noble idea.
Simply let the County Councils take over. They are already trusted with most of the health services listed earlier, and with social care. They can far better understand local needs and make the decisions people want. Local government is much nearer to the homes and hearts of the people than any national government or CCG can be. They can experiment across the totality of health services, in a way a hospital service can’t. It is difficult to imagine, for example, Gloucester Royal Hospital building high-quality housing. The council could.
Councils too could tailor health services to health needs. Currently, the decision-making bodies are either hyper-local CCGs or national organisations. Moving choices about pay or services could loosen up the whole system. It could provide that elusive goal of free and equitable healthcare. Good practices could be copied, and malpractices learnt from. When combined with adequate funding, allowing differences and democracy in health services could be a great thing.
Abolishing the NHS does not mean the end of free healthcare. By vesting its responsibilities in county councils, a holistic and more dynamic Health Service may well emerge; one which would go some way in curbing the rise of large, impersonal and ineffective government.