John Ruskin, Modern Painters, Volume 5 (1860)
Cornish academic Bernard Deacon tweeted this week that if you think Labour can be trusted on the NHS you should remember what they did to it last time they were in power. It was a year at the weekend since the death of one-time Bristol MP Tony Benn, who predicted a revolution should anyone abolish the NHS. Well, there’s been a huge amount of tampering and so far we’re still waiting for the reaction to start. That’s partly because of the cross-party consensus that the NHS is to be dismantled by stealth and partly due to an unwillingness to consider less familiar parties to support in defence of it.
Simon Jenkins, writing this week in The Guardian (a London newspaper), suggested that what’s needed is a more integrated service. Why aren’t pharmacies based in doctors’ surgeries? A very good question. In recent years the NHS has spent a lot of money relocating surgeries to better premises, sometimes a long way from their old ones, but the pharmacies haven’t necessarily moved with them. Why is it not thought through from the patient’s point of view?
If we had a real NHS, with all prescriptions free, there’s no reason why pharmacists, like doctors and nurses, should not be an integral part of it, even if they remained as private businesses under contract. The NHS could, for example, save the cost of printing paper prescriptions, the order simply passing from the doctor’s screen to the pharmacist’s to be made ready for collection before the patient leaves the surgery.
For a generation now the idea has been that we need to break up and privatise the last of the ‘socialist monopolies’. A UKIP spokesman even described the NHS as the ‘Reichstag bunker of socialism’. (Next time the cheeky chap’s in Berlin he might like to check the geography: the Reich Chancellery bunker, if that’s what he meant, was nowhere near the Reichstag.) They’re all barking up the wrong tree, quite possibly the money tree of private profit. What the NHS needs is not less socialism but more, with full integration of all caring services in each locality and region, and full democratic accountability for all non-clinical decisions. Plus, of course, the flushing-out of PFI and all other forms of vampire finance. If the State has to go crawling to bankers for the cash to do good then the cash is plainly in the wrong hands to begin with.
The NHS thus re-imagined would be a prime example of the community-benefit State in action. That is to say, a State that organises essential services, whether publicly or privately delivered, for the benefit of the community, not that of funders or providers (whose interests are NOT the same as the community’s). A State therefore in which elected representatives ask searching questions about why things are done as they are. It’s about getting more out of less, rather than hoping for increased resources that in the longer term will not be there. The community, as the beneficiary of what works, must also be the judge of what works. It should be unthinkable to bypass the community in favour of bureaucratic assessments over which the community does not have the final, or indeed any, say.
Health and well-being at an individual level are also the product of the health and well-being of the environment and the society that we inhabit. Preserving, rehabilitating and enriching our land and our culture are part of creating a sense of home in a world where roots are increasingly being torn up. The defence of Wessex must be about meeting all our irreducible needs, without encroaching on the ability of future generations to meet their own needs. That was where the classic definition of ‘sustainable development’ was leading us but, since posterity doesn’t have the vote, the current generation is taking much more than its fair (or healthy) share.
Regionalism is neither necessarily of the Left nor necessarily of the Right and so is open to allegations of inconsistency from both. The fact is that it’s strictly empirical, guided by what sustains our communities in reasonable liberty, reasonable security and reasonable comfort. It cannot create health any more than it can create happiness. But it can remove the barriers that remote and undemocratic centralism and its matching market obsessions have erected against both.