At the airport in Moscow during Soviet times it was sobering for foreign
visitors to reflect that by leaving the country we were exercising a freedom
denied to Russians. The borders were sealed because otherwise millions might
leave. The old joke ran: “What is a Soviet string quartet?” Answer: “A
Soviet orchestra on return from touring the West.”
A news item last week reminded me of those Soviet days. The British government
resisted a European Union plan that would enable us to avoid long waits for
medical procedures by travelling abroad to receive treatment. The National
Health Service would then have to reimburse us. It is the first good idea
from the EU that I can recall, so it was depressingly predictable that
Britain would oppose it.
One reason given was that it would disrupt the NHS’s ability to plan new
hospitals. Ah yes, in the old days the five-year plan was always sacrosanct.
Patient choice might disrupt it and so must be blocked.
Of course, the reason why the plan might be shaken is that there could be an
exodus of patients. All the statistics showing that waiting lists have
shrunk might be exposed to doubt if hordes of the lame headed off for
prompter operations elsewhere. Ministers’ complacent statements about
improved health outcomes might be challenged if patients demonstrated that,
despite irksome journeys and linguistic barriers, it was all worthwhile to
secure better medical care in France or Germany.
State servants queued to denounce any freeing of the “market” in health
treatment. Frank Dobson, a former Labour health secretary, feared that it
would create a two-tier health service because it would suit those who can
afford to pay upfront and await reimbursement. The British Medical
Association and the NHS Confederation joined the ferocious attack, leading
me to think that the EU’s proposal must have real potential.
A Department of Health spokesman said: “We think it is critical that . . . the
NHS retains the ability to decide what care it will fund.” So there we are:
the needs of the state are critical and patients’ needs are less so.
Dobson’s remark is quaint. Even the idealists who established the NHS in 1948
knew that two tiers were unavoidable in anything that could pass for a free
country. So Labour’s health minister at the time, Aneurin Bevan, allowed
surgeons to treat private patients in NHS hospitals.
When later that Labour government was torn apart by the Treasury’s proposal to
introduce certain health charges, Tony Benn wrote: “On this question of
‘principle’ of a free health service, it is nonsense . . . There is only one
test we can apply and it is an overall one: ‘With what we have and can get
by way of revenue, how can we lay it to the best advantage of those who need
it most?’ ” The test seems valid today. Since that remarkable postwar Labour
government, legislators have undone much of its work by privatising
railways, gas and electricity. But the NHS has been left intact. Despite the
vast increase in people’s incomes over the past six decades, the state still
tries to pay for all our health needs and resists our efforts to provide for
ourselves.
Indeed, the NHS now restricts us in ways that might have made even Bevan raise
an eyebrow. Take the case of Colette Mills, a cancer patient who tried to
top up her NHS treatment by buying privately a drug that the service would
not supply to her. She was told that if she did that she would have to pay
for all her drugs. The state’s Canute-like attempt to hold back a two-tier
medical service is more important than saving life. No wonder that one
cancer expert, Professor Karol Sikora, described the policy as “ideology
gone mad . . . medical communism and utterly immoral”.
Any rational policy-maker, perhaps inspired by what Benn wrote in 1951, would
look to see how the state’s meagre resources could be supplemented by those
able to pay a bit. European comparisons show that in the UK the state’s
share of health expenditure is the highest of the big countries. Not
surprisingly, then, our total health spending, taking public and private
together, is lower than most. Perhaps the government does not want us to
travel abroad for treatment because we might then discover that other
countries have better ways to spread the burden of rising health costs.
Despite Labour’s postwar fixation with nationalising things, at least it did
not establish a National Education Service. But we have effectively created
one since. Successive governments abolished most schools except
comprehensives, increased central direction over what should be taught and
how, and undermined the independence of the universities.
The state is no better at educating than at supplying electricity or
operations. We should not be surprised that in a Unicef report on children’s
well-being, published this year, Britain was bottom out of 21 countries
surveyed.
The state’s rules are always arbitrary. In education you are allowed to top up
the state’s provision. When Tony Blair bought additional tutoring for his
children, nobody told him he would have to educate them privately.
Depressingly, as the failures of the state in health and education have become
clearer, political consensus on maintaining existing policies has grown. I
have played a part in that by urging the Tories to eschew radical policies
that might frighten a deeply conservative electorate.
Secretly both parties realise much is amiss with education. Both know that the
system fails bright children, which in turn threatens Britain’s ability to
compete. While David Cameron fears to pledge new grammar schools, he
proposes setting by ability by subject. The secretary of state, Ed Balls – a
man with a 10-year plan! – has a scheme for helping “gifted and talented”
children. It looks ineffective but shows he can recognise state failure.
Both parties favour unannounced schools inspections (because they do not trust
what goes on in classrooms), and while the Tories say that they would allow
professionals to get on with their job, in fact they intend to be more
prescriptive about how children are taught to read. That is because they
believe trendy theories have betrayed a generation of young pupils.
However, Conservatives realise that the state’s professionals can outwit them.
So the best way to improve education is to break up the state’s monopoly.
That insight was shared by Blair, who struggled manfully but ineffectually
against the Establishment, his party and Gordon Brown to introduce
alternative provision, in the form of city academies.
The idea was originally Conservative. Now the Tories would like more
academies, to which Lord Adonis, the education minister, retorts, as a good
state servant would: “People will ask why we need a new academies programme
when the current [one] is working well.” In other words, do not question
what the state has deemed sufficient.
The Tories really want to go further by allowing anybody to set up a school
where fees would be reimbursed by the taxpayer. The idea has been a success
in Sweden, where about 15% of secondary pupils are taught in such a manner.
But whereas in Sweden these schools can be run for profit, the Conservatives
propose that in Britain profit would be banned. That could make a crucial
difference, as the Tories understand better than anyone.
It is comic that the Tories refuse to endorse a free market scheme that for
the past 15 years has worked well in socialist Sweden. Alas, their timidity
is probably justified because the public still does not trust them.
You wonder how bad public services would have to get for people to demand an
end to state monopoly. I am not optimistic. In Russia, years of grim
stoicism seem now to have given way to nostalgia for the good old bad old
days. The British voter, short-changed by the bureaucracies that deliver
health and education, takes it all on the chin, fearing change above all
things.
