NHS. Bottomless pit

The question of NHS organisation is likely to rumble on for some while. Quite a few commentators remark that there is a lack of understanding among the populace as to why any change is required. The first coconut shy at reform was so widely condemned and so little supported in today's report that it is clear the government itself is out of tune. I feel that there has been a lack of clarity in stating why reform was mooted. As I see it, the elephant in the room was cost. The changes that were made over the past x years and those more recently advanced can all be traced to funding. The non-nursing side was inflated as more and more controllers and administrators were taken on board. Budgets cannot be considered viable where a local problem will require action that could not be foreseen. The overruns cause headaches for any Chancellor.

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A more useful examination would be to try and establish ground rules as to what the NHS will do and what it will not do. These will involve a tremendous soul searching. It is totally understandable for people to expect that the NHS will, as was promised, care for them from the cradle to the grave and that the very best care will always be afforded to them. This is the pathway to the bottomless pit. For example, we currently sustain children born after, I think, just 24 weeks in the womb. Those whose child died at 20 weeks will press for research and improvements to bring the 24 down to 20. Then there will be pressure for the safe delivery of the 18 week fetus. IVF is an expensive procedure. Some of the demand for it is from women who delayed conception in favour of a career and the need comes from their age or their having exhausted their stock of eggs. We seem to be able to get them pregnant to the age of 60. Scotland has (as usual) led the way with an upward limit of 38 years. There would seem space there to control costs. Some of the extreme end of life conditions have very significant costs despite the efforts of NICE; could we not set a definite point or a medical state where all that will be offered is palliative care? Those whose medical or mental problems have arisen from self abuse with drugs or alcohol should not qualify for anything other than first aid or, again, palliative care. We may remember the footballing legend given a liver who then continued his alcohol abuse until he destroyed the replacement.

As I have said, there would be tremendous public outcry at the mere suggestion of such controls, But think - had these been in place at the time the NHS was introduced. we would have accepted them as being far better than the 3 old pence a week private insurances. There can be little point in having universal 5 star health provision if,for example,we have 2 star education, 1 star defence or 0 star full employment because all the money is going to state of the art medical facilities.