Phil Taylor is a Conservative activist in Ealing.
Never mind “humanitarian crisis”. It will be an economic disaster, one that will have a long-term and large effect on our national wealth, if we replicate the failed NHS model in the social care sector. Caring for the elderly and making the right choices, as we navigate this key demographic issue of the twenty-first century, is one of the biggest decisions this generation has to make.
With the onset of the annual NHS January crisis, voices are again raised in calling for a centralised, state-provided, taxpayer-funded National Care Service run alongside the NHS and closely integrated with it. These calls invite us to replicate all of the mistakes made in the NHS in another large slice of the nation’s economy. This will further increase the size of the state – undermining our national productivity and future prosperity.
A look at the waiting time statistics show that, whilst we do have larger issues today due to higher demand, there has been a winter crisis every year in recent memory. How can you claim to be efficient, as supporters of the NHS model claim, if you can’t deal with something as predictable as the seasons? You do rather wonder if the annual January crisis isn’t an excellent opportunity for the producer interests in our state health system to ask for more money every year? Why would you ever engineer it out?
The NHS already consumes nine per cent of our GDP, and our health spending is in line with comparable OECD countries. We are mid-table. If the monolithic NHS model really was as efficient as its fans proclaim, we might expect a large outperformance in outcomes for our mid-table investment? But no, we often achieve poor outcomes compared to countries that spend less than us.
So now we are told the NHS should effectively take over social care. Unfortunately, its business model and labour costs will cause costs to rise massively whilst outputs will stagnate.
Disparities in prices paid by the NHS for items we all buy often hit the headlines, but these costs are small compared to the mismanagement of drugs and clinical supplies costs, and trivial compared to some of the major structural issues in the NHS.
The NHS lacks focus on outcomes and fails systematically to drive out bad practice and innovate, leading to poor outcomes for patients, high costs and large bills for clinical negligence. This really should be one area where an efficient and principled state provided service should excel – but no.
Having been founded on the principle of the state appropriating the assets of charities and local councils the NHS has always been terrible at managing property and indeed NHS bodies often don’t pay rent and use space very inefficiently as a result.
As Andrew Laird pointed out last month on this site, NHS bodies, unlike local councils, are not required to balance their budgets which leads to financial mismanagement which has been largely eliminated from local government.
The terms of trade with the workforce in the NHS are just awful. NHS staff retire at 60 and many retire at 55 – especially GPs, whose pension is so generous that they can afford to retire early leaving patients to queue. According to the NHS Terms and Conditions of Service Handbook, NHS staff with ten years service get 33 days holiday plus eight public holiday days a year. Even new joiners get 27 days! In addition, ten days of extra holiday can be purchased, leading to yet more holes in rotas.
There is a culture in the NHS of going on the sick. Essentially, nobody asks questions if you don’t exceed 10 days off a year. This results in the latest NHS sickness rate being 3.9 per cent – or more than double the 1.8 per cent rate in the private sector.
Simply bringing NHS terms and conditions and practice into line with the private sector would bring savings worth up to 10 per cent of all NHS spending. If, on the other hand, we were to apply NHS terms and conditions to the social care sector, we would see a massive increase in costs for no patient benefit.
The 2004 GP’s contract, which gave patients a worse service in return for more cash, would look like small beer compared to a nationalised National Care Service which would simply result in very much more being spent and less care being provided. And don’t expect that annual January crisis to disappear either.
There is a patient-centred, distributed, flexible, high-quality, low-cost solution to the social care crisis but it will not come from the NHS nor central government. And it will probably be all the better if it is paid for directly by its users – even if many of those have state support. More on that another day.