I’m in Torquay this week, at the CPHVA conference. The CPHVA is part of Unite, the section of our Union that organises health visitors, school nurses and nursery nurses.
One of the speakers yesterday was Martin Knapp, Professor of Social Policy at the LSE. His background is economics, and his work currently is around analysing the financial costs of health care.
I was incredibly worried by his starting point. He told us that scarcity, rationing and careful choice were facts of life. We had to accept that decision makers would look at the costs and the achievements of different health interventions, and use cost as a major contributor in their decision making.
He talked about the high cost of health visiting – research shows that early intervention is effective, but health visitors cost £72 an hour, and then they refer children on to other services with ‘cost consequences’. Is this cost effective? Services for people with mental health problems could be justified, though, if there was evidence that they went to work and became economically productive as a result. The message that Martin reinforced time and again was that resources are scarce, and rationing is inevitable.
Like a lot of TU activists, I’m well used to thinking up speeches, sticking up my hand, and not getting called to speak. This is the speech I would have made if I’d had the chance!
The starting point of accepting scarcity and rationing in the NHS is wrong. I work with children with severe disabilities. Their care will always be costly. By definition, they won’t be economically productive. Forty years ago we would have called them ‘ineducable’, stuck them in institutions, and left them to rot. We don’t do that any more because as a society we’ve moved on. We haven’t made the same progress unfortunately with older people – maybe that’s because society still sees older people as unproductive, and that’s why they often still get such poor health and social care.
Martin’s right that it’s about choice though. If we accept the concept of a fixed and finite pot of money for the NHS – and I don’t – we could choose to spend less of it on constant reorganisation, and we could choose not to waste vast amounts of money on privatisation.
Or, even better, we could look at choice a different way. As a society, we have choices to be made – between Trident replacement and war in Iraq and Afghanisatn on the one hand, or investing in health and education on the other.
Of course there are careful choices to be made – incredibly important choices. But the choices can’t just be financial – they have to be about our collective values and what kind of society we want to live in.
I’m sorry I didn’t make the speech. I suspect most CPHVA members would have agreed with me.