The NHS Is Doomed

No election should be fought on a single issue. No party should stand on a single issue - one of my main problems with UKIP outside the rampant fascism is their focus on immigration at the cost of everything else. However, the NHS is a massive issue that should have totally dominated this election, far more than taxes, immigrants or the EU.

The NHS is a socialist ideal - free healthcare for all. It's a very simple, very expensive ideal. It was introduced as a post-war reform, to centralise, regulate and democratise healthcare. Prior to this, healthcare was paid for either as it was necessary, or by insurance. My granny and her sister were in hospital for weeks with diphtheria in the 1930s, and that was paid for by their father's work 'stamp'. There was a lot of self-medication then as well - this being in the days before antibiotics - mostly with unregulated supplies of opiate based medicine. Colicky baby? Opiates! It was to be paid for through work-related National Insurance, which was not dissimilar to what most people were used to paying anyway. It was an ideal system.
The NHS, since those days, has mutated into an enormous, bureaucratic beast. In attempts to save money, managers were brought in to regulate practice. They have ended up sucking more money out of the NHS in wages than they save in administration. I was an NHS administrator, I know we are very necessary people, but I was on minimum wage to begin with and some are on hundreds of thousands of pounds a year.
Labour had some interesting ideas on how to make the NHS more profitable - mainly by getting private firms to build hospitals on a sort of hire-purchase agreement. Then they started selling off the buildings and responsibility for hospitals and GP surgeries to private companies. That worked fine, until the private companies decided they couldn't afford to run them anymore, and withdrew. You see, that's the real problem with privatising aspects of healthcare, as it has been with privatising other public services. When it ceases to be profitable, the private sector simply run away. Free healthcare is not a very lucrative business, so this is likely to happen a lot more in future.

The coalition government also made a lot of cuts to the services offered on the NHS, as well as raising prescription costs enormously (£7.20 per item in 2010 to £8.20 in 2015). In a startling deviation from my usual lefty saucepan-banging, I believe prescription costs should be around £0.50 per item, but applicable to all but the critically ill and the extremely poor. I know how much medication costs wholesale: it shouldn't be free to as many people as it is, but neither should it be prohibitively expensive. The coalition government also cut staffing, particularly in nursing where I suppose they think people won't notice, and in A+E departments, where people certainly do. 

The problem with the new Conservative government and the NHS is that the Conservatives are ideologically opposed to the NHS. This isn't me being a bleeding-heart liberal: they believe in telling us what to do to keep healthy, and that is as far as it goes. The Conservative viewpoint on health is that it is your responsibility, your fault and your problem if you're ill.
Thatcherism took this even further into the realms of market liberalism. Don't be fooled by the name, the liberalism refers to the freedom of the markets, not you. Market liberalism holds that the market should be free to set costs without government interference. So not only are you ill (which is your fault), your treatment price is inflated. Hurrah for Thatcher (said nobody, ever).

And the thing is, that would be FINE if health was merely down to a matter of personal responsibility. But we all know it's not, even if we try and convince ourselves ideologically that people give themselves cancer, or depression, or chronic disease. We all know someone healthy cut down in their prime by some apparent fluke illness or accident. We all know someone who's done every single recklessly unhealthy thing you can imagine and lived to a ripe old age.

One of the biggest factors in your lifespan and your years of freedom from disability is your wealth. The more money you have, the healthier you are likelier to be, and the longer your life. There is a nine year gap in average lifespan between the richest and poorest areas of the UK. NINE YEARS. Not only is there that lifespan gap, there's also a huge gap in experience of disability.

Now, there are loads of reasons poor people experience poor health, and very few of them are down to personal factors. One of the main reasons is infrastructure. When you live in a poor area, your access to doctors, hospitals, transport, nutrition, good housing, employment, and exercise is limited. Your exposure to pollution, cigarette smoke, accidents, antisocial behaviour, stress and housing-related issues like mould is increased. Education also has an important, if unexplained, effect on health - more educated people tend to be healthier, and schools in poor areas tend to have lower qualification rates.
All of this is exacerbated by work. If you are fairly well off and work in the private sector, it's likely that you have a sick pay scheme. You may even have health insurance. Even so, suddenly being unable to work for a long period of time can be a disconcerting, depressing and stressful experience. However, when you work in lower class employment, or in the lower sectors of the public sector, you are dependent on statutory sick pay. SSP is currently £88.45 a week. You cannot claim SSP if you are on a zero-hours contract, or a very low wage. It's eligible for six months, after which you either continue on nothing, be sacked for continual absence and thus ineligible for jobseekers allowance, or leave work and switch to a disability benefit. I know a lady who was sacked because she'd had too many periods of sickness in the last few years, and then had a bad chest infection. Her previous absences were due to having chemotherapy. This was perfectly legal. Naturally, switching to a disability benefit is universally considered a bad thing by the Conservatives. Far better to keep the working masses in work, surely?

Yet it is the working mass, the seething, swarming low-paid mass, that needs the NHS most, potentially costs the benefit system most, and is capable of paying back into the economy. These are the people the Conservative government would prefer did not exist. The people they wish would be as wealthy as they are, so they didn't have to worry about society. The people they continually push down the ladder through social and economic inequality, and then seem surprised when it costs the state money to do so.  I'm sure there are plenty of individual Conservative MPs and voters that staunchly believe in the NHS, but that's not the party line, so they may as well piss in the wind.
Thatcher said there is no such thing as society. Unfortunately for her acolytes, there is, but don't expect the gentle dismantling of the NHS infrastructure to stop now the coalition has ended.

Expect it to get worse. Expect it to become more overt. Expect to become anaesthetised to the idea that the NHS is a salvageable , workable entity. Expect to be unsurprised when it's rebranded, or you are asked to put down a deposit when making a GP appointment 'to ensure your attendance'. Expect GPs to be blamed. Expect A+Es to be blamed. Expect managers to be blamed. Expect ill people to be blamed. Expect immigrants to be blamed. In fact, expect everyone else to be blamed for the sad, but necessary dissolution of the NHS except the government.

I love the NHS - I love it as staff, I love it as a patient, I even love it as a parent of a disabled child, where it's failed us most.
I hope I'm wrong about this. Ask me in five years.