If defence - which I’ll cover in my final ‘policy post’ tomorrow - is the fundamental priority for government itself, healthcare is what matters most to us as individuals and families. Everyone, of every political opinion, cares about the NHS and the care system, and even diehard Conservative voters frequently raise it with me as a cause for concern.
The problems we face in this area are only partly because of Covid-19, though the pandemic did deliver the biggest shock and challenge to the NHS since its foundation. We are still struggling to cope with the excess demand induced by the pandemic: both the deferred treatments from 2022-23, and the additional ill-health (including mental ill-health) caused by the virus, by the lockdowns, and (I suspect, and want more research here) by the vaccines.
But the NHS was struggling before 2022, and this despite record investment in the system over many years - despite the myth-making, the NHS was not ‘starved’ of resources during ‘austerity’, but received a total real-terms increase of 25% in its budget over the years from 2010 (including delivering five-fold on the famous ‘£350 million per week’ promise made by Vote Leave). Since 2019 we have 20% more GP appointments and the largest-ever investment in the local NHS through the expansion of Great Western Hospital in Swindon.
The NHS struggles because (like other healthcare systems across the world) it has been so successful at keeping people alive, using expensive treatments; and because although we live longer many of us have long-term conditions, in part due to the unhealthy lives we lead (40% of healthcare demand is driven by personal choices over diet and exercise). We are an ageing and an unwell population.
A few years ago I recorded a conversation with Marlborough doctor Nick Maurice, the seventh in a line of Dr Maurices in Marlborough going back to the 1790s. Nick described the NHS he began practising in fifty years ago: local, ‘relational’, preventative, human. The tragedy of the modern healthcare system is that it is none of those things. It is centralised, bureaucratic, reactive, and - though frontline staff do heroic work - in practice, often inhumane.
On the doorstep I often find people who describe amazing work done by the local NHS, whether through GP surgeries or at Great Western or Salisbury District Hospital. But I also hear - including from NHS staff and GPs - of chronic waste, of a culture of back-passing and back-covering, and of rules that frustrate the common sense decisions of professionals trying to serve their patients. Doctors at Kennet & Avon Medical Partnership in Marlborough told me last week of the absurd rules that prevent them using NHS money - which is available - to directly recruit a GP colleague; instead they have decided to do so out of their own income, personally subsiding the NHS because its rules won’t let them do the obviously necessary thing.
My party has made various pledges if we are re-elected to government. On dentistry - a critical challenge - we will increase the funding to make NHS work more attractive to dentists, with a premium for taking on new patients. We will continue to expand the number of dental training places and consult on a new ‘tie-in’ for graduates to stay in the NHS for a period after qualifying.
We will continue to provide above-inflation funding increases every year; cut the number of NHS managers by 5000 to invest in front-line staff; deliver on the 2023 target for 40 new hospitals; but also focus on community care - as in the new Devizes Health Centre which I was proud to deliver for my constituency in 2023.
And on social care, the great unreformed system which no party since the creation of the NHS in 1948 has properly tackled, we will deliver our commitment - delayed by the Covid crisis - to cap the costs any individual will have to pay at £86,000. You will only be liable to pay all your care costs (up to the £86k cap) if you have assets of £100,000 or more, and if you have less than £20,000 in assets you won’t pay anything.
We will support care workers, a vital mainstay of our society, with a stronger accredited professional pathway, and provide multi-year funding for councils so they can plan their budgets more efficiently.
Reform of the NHS and social care system is imperative. I hope that if Labour win this week they will build on their much-boasted ‘creation of the NHS’ (actually a cross-party effort) and modernise it for the times we live in. I will actively support them if they do. If the Conservatives manage to hold on to power I hope we will work with all parties, the professions and the public to deliver the NHS and care system we all so badly need.
