Wednesday, 21 January 2015

It's really time our debate about health grew up.


Our national debate about health is a shambles. Indeed, 'disgrace' is probably the best way to describe how politics debates the issue that remains with economic well-being the single most important issue for most people. I am grateful to Jackart for 'Bracken's Law of NHS Debate':

"The longer any discussion about the NHS goes on, the closer the probability a spurious invocation of the US system of healthcare gets to one, and whoever does so has lost the argument"

The minute anyone uses the word 'competition', 'market' or 'reform' those with a vested interest respond with reference to the US system (which somehow manages to be both very expensive and wholly captured by producer interests).

The other, and closely related, aspect of the debate is to invoke the caring nature of nurses, doctors and others who work in the NHS. And to imply that, without the NHS, none of this would be there. You'll have heard people exclaim: "my mother (or child or spouse or sibling) is alive today because of the NHS".

To which my response is to ask whether that person would be dead had they lived in France, Holland or Sweden - none of which have a centralised, bureaucratic, national health system. But you can't win with this argument because the shameless and disgraceful debate kicks in with shouty stuff about "selling off the NHS" or even "you don't care about Our NHS".

We have a huge challenge in our health service that isn't being discussed. Or rather it's not being discussed by the national political leaderships, by the representatives of health care producers or by the media. At the very local level people are prepared to discuss how we deal with an ageing population, how we strike the balance between social and health care, and whether our spending priorities are entirely geared to meeting the real health challenges we face.

Yesterday - as the motion's proposer made very clear - Bradford Council didn't debate a motion about public health. We went straight to the vote. Now, to be honest, the motion was a good example of us not facing up to the truth about health spending - instead of asking what Bradford Council was doing with the £30m or so it gets in public health funding, all the motion's proposers wanted was a line in every report asking "what are the implications for public health". This would join similar lines on "sustainability" and "trade unions".

The thing we should have asked was whether the way we're spending that money right now is the best way to help get better health for Bradford's population. And maybe suggesting to the government that they trust local councils and lift the ringfence on public health money would be a start. However valuable smoking cessation clinics might be (and the answer is actually 'not very effective') would the money - three-quarters of a million - we spend there not be better directed to helping keep the wheels from falling off our social care system and keeping old people out of hospital?

If we want a better health service (and right now ours really isn't good enough) then we need to discuss how to get such a service. Instead we refuse to discuss the choices facing us because we fear 'Bracken's Law' and the shouty ignorance of those most interested in keeping the status quo. It really is time our health debate grew up.


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