ANDREW ADONIS: Will Boris Johnson become a convert to the gospel of the NHS?
- Credit: PA
ANDREW ADONIS wonders whether the prime minister will have undergone a conversion during his coronavirus treatment at the hands of the NHS.
Has Boris Johnson's resurrection on Easter Sunday converted him to the national religion? The NHS, that is, not the Church of England.
'The National Health Service is the closest thing the English have to a religion,' Nigel Lawson said after his attempts to open a debate about partial privatisation failed under Thatcher. 'Those who practice in it regard themselves as a priesthood and faced with a dispute between their priests and ministers, the public have no hesitation in taking the part of the priesthood.'
Johnson, like Lawson an ex-editor of the Spectator, once sought to defrock the priests. In 2002 he invoked 'the experience of other countries that have a far better record of health care provision… because they do not rely exclusively on a top-down monopolistic service of the kind we have in this country'.
That would be the 'top-down monopolistic service' which saved his life in St Thomas' Hospital, whose nurses – including 'Luis from Portugal and Jenny from New Zealand' – he praised by name in his resurrection video.
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The mechanism traditionally favoured by the Tory right to turn the NHS quickly into a residual service for the poor is to give tax breaks for private healthcare. When the Blair government removed the last of these, Johnson said: 'People are being driven to use private medicine in despair at the NHS. There should be no shame in pointing that out.' He isn't any longer 'pointing that out'.
The equally effective way to undermine the NHS is to underfund it. This is the austerity policy adopted by Tory governments since 2010. Under Blair and Brown, annual spending on the NHS increased by 6% above inflation a year, nearly double the 3.3% annual average increase under Thatcher and Major. Under Cameron/Osborne after 2010, this was slashed to barely 1% a year, raised only to 2% by May.
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In last December's election, Johnson heralded billions extra for the NHS. But they amount only to a year-on-year real increase of 3.3% over the next three years, which is back to Thatcher but miles short of Blair.
Even that increase is only for the NHS. Equally important to the actual health provision needed by most of the elderly is social care, which is largely dependent on local authority budgets slashed in real terms since 2010 and still being cut. This is why Theresa May proposed her 'dementia tax' in the 2017 election.
The voters didn't think much of that idea and Johnson has not revived it. But he has no policy to deal with the escalating social care crisis for which there are now only two viable policies: make social care part of the NHS, maybe subject to means-tested charging for the 'hotel costs' element of care, or to be explicit about the logic of the existing policy of privatisation of care for most of the elderly with a residual local authority service just for the poor.
I favour the NHS option. Johnson won't tell us which he favours, which means he is privatising by default. A prime virtue of the NHS is that it both humane and efficient. It removes worry about fees and two-tier provision that applies in insurance-based systems, even those which (unlike the US system) ensure universal coverage. It also eliminates the red tape mountain of insurance systems as they allocate and recover costs and charges.
To see what might happen if we moved to an insurance system, look at the state of British dentistry. Most treatment is private, with only a residual NHS service. In large parts of the country it is virtually impossible to find an NHS practice, and those few are largely staffed by the dental equivalents of Luis from Portugal and Jenny from New Zealand.
'In the beginning was the NHS free to the faithful,' begins the new Gospel according to Boris. But the next verse is equally vital: 'And the Lord said: 'thou shalt end the famine of funding which afflicts my doctors, nurses and care workers. The NHS shall receive at least 4% real growth in spending from taxation each year, lest it otherwise perish.' This is the promised land.'