The NHS cannot deliver its central mission on its own
3 min read
The NHS must see itself as a player in a team of other local public services to improve effectiveness for all, says Stephen Dorrell
The NHS has a legendary capacity to mobilise public opinion. Danny Boyle used it to illustrate the essence of Britain during the opening ceremony of the 2012 Olympics; Ed Miliband talked about “weaponising” it in the 2015 general election; Nigel Farage did exactly that with his bus during the 2016 referendum.
The NHS is more than a healthcare system. It is, as Nigel Lawson famously said, the nearest thing we have to an established church. This status is both its greatest strength and its greatest weakness.
Jeremy Hunt recently used its strength to secure a unique spending commitment from the Treasury. Real spending increases of 3% per annum over five years is not enough to secure the improved health and care system about which the secretary of state often talks, particularly when the government is silent about the outlook for social care, but it provides a medium-term context for service planning which is not available to any other public service – as they have been quick to point out.
But it is this ability of the NHS to claim that it is a “special case” which is also its greatest weakness, for two principal reasons.
First, it encourages the natural tendency of the health world to talk to itself. It has its own thinktanks; its own publications and conference circuit, its own commentariat. It develops its own narrative and convinces itself that it is right.
That tendency to insularity leaves it exposed to examples of shocking failure such as Gosport and Mid Staffs, as well as more general system inertia in the face of powerful and disruptive agents of change.
The second negative consequence can often, perversely, be to undermine the effectiveness of the public services seen as a whole. This arises because spending settlements which discriminate in favour of the NHS have the effect of diverting demand from other less generously funded services into the NHS.
This is now widely acknowledged to be true of social care, but the same argument applies in social housing and other local public services. When social support is most easily available to vulnerable people through the NHS, that is where they will go.
Even when this “diversion effect” is recognised, it is too often expressed in economic terms. It is said to be “wasteful” to use acute hospitals to provide social care, or to provide residential care to people who simply need social support.
But surely this approach completely misses the most important point. It is not only bad economic policy – it is appalling social policy.
The NHS cannot deliver its central mission on its own; its biggest challenge in the years ahead will be to break out of its comfort zone and ensure that its privileged status in public spending is used to create services which are joined up with surrounding public services.
Otherwise, the National Health Service deteriorates into a National Illness Service.
Stephen Dorrell was Conservative health secretary from 1995-97
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