…as we here in the UK digest the results of the latest Public Spending Review, it has struck me that the conversation about expenditure has been a rather one-sided affair. I’ve heard few people talk about spending on public services as an investment, it seems that in times of austerity (for some and less for others) it is only ever talked of as a cost, as if by spending our money on funding Public Services the government is somehow doing us a huge favor that they are not obligated to undertake. The National Health Service is probably the greatest example in the world of the concept of collective taxation being harnessed for the common good of the wider population. Sure, the execution of the concept can leave a bit to be desired, but the idea itself is flawless; the pooling of our collective resources to provide essential services that none of us on our own (except the billionaires travelling on Russell Brands diamond encrusted fun bus) could ever afford to set up. I blew my personal capital expenditure budget on a small wooden summerhouse this year, a private hospital in the back garden was a little beyond my means.
John Ruskin famously observed that “There is no wealth but life”…and despite the fact that he came from a uniquely privileged background and was therefore singularly unqualified to make observations about what should be important to everyday people; I think he was a decent sort and on this occasion was probably pretty near the mark. Of course, the caveat being that Ruskin’s idea of what constituted “life”, three or four meals a day accompanied by port and cheese, was probably very different to the average person living in England in the mid 19th Century. This was after all the era of Dickens, who’s razor sharp observations about the horrendous living (existing?) conditions of the working class led to a long overdue period of social introspection…perhaps even preparing the UK psyche for the setting up of the NHS over 70 yrs after his death? Who knows, but for me as a lifelong admirer of Dickens work, its a nice thought.
Of course the health and wellbeing of a nation and the responsibility for it is much more than just the preserve of a National Health Service. In some respects our increasing need for and our use of the NHS in the UK is simply a measure of failings in other areas; Alcoholism, Obesity, Smoking Related Cancer and Drug and Stress Related Mental Health to name but a few. And whilst I have no evidence to support the following statement, I would say that the NHS has created a sense of learned helplessness within many parts of society in as much as people now know that the NHS will pick up the pieces when things break so why worry too much about taking personal responsibility for managing and maintaining your own health if the state will sort you out when you need it. This thinking also applies to many less responsible organisations, those paying poor wages and offering a poor employment experience are also relying on the services of the NHS to continually prop their employees up with whatever physical and mental health services they develop as a result of such employment; economists call this “the externalizing of cost”, its a posher way of saying, “causing problems and letting others pay for fixing them”, and whilst it is morally abhorrent it is commercially favorable. There is no easy answer to this.
And so in the wake of the latest Public Spending Review another Public Sector strategy goes by the bye…for the last year many within the NHS have been fixated on something called the Five Year Forward View. Its a classic Public Sector strategy document in many respects, it is one of the better ones in that there is some good stuff in there and it is shorter and more readable than many, but nonetheless like many Public Sector strategy documents and plans it is short-term in nature; is five years really a long term view on something of critical social importance or just the average length of time you might invest in an ISA? And it is heavily reliant on things over which it has little if any influence; i.e. the health of the wider population, which in strict terms could be seen to undermine its right to be called a strategy. The document contains a section entitled “Getting serious about prevention” in which it suggests that spending and activity related to prevention and the promotion and development of better Public Health are key to enabling the NHS to live within its means. The latest spending review with its cuts to Public Health has of course put paid to that. But this should be no surprise, the Public Sector will always be awash with strategies that hang on “ifs and buts”… as a local farmer once said to me, “If ifs and buts were whisky and nuts we’d all have a cracking good Christmas”.
But, regardless of some obvious flaws in execution, and despite seemingly intractable issues around the deserving of those who need and use it, I think it is time for the NHS to start talking more about the good that it does as a worthwhile investment and not a cost to the Public Purse. This means that the NHS needs to develop its own understanding of the good it does, not just in terms of the numbers of people it treats and helps; few people have ever leaped from their beds to achieve a Public Sector target and I’ll wager many have stayed in their beds because of them…but in terms of the impact that health services have upon the people that use them, their lives, their families and loved ones, the communities they live in and the businesses they work for.
How many people have achieved personal goals, held jobs, maintained relationships, kept hold of homes, avoided injury and even death and gone on to be of great value to humankind because they have had access to health services? How many small businesses and self-employed people have kept going and been able to grow and thrive because they have had access to health services? Health services are an essential part of the infrastructure that underpins everything else that happens in our society; we need to start to learn to talk about ourselves in a more meaningful way.