"Stop this sick joke, Gordon, before it becomes terminal
What follows will fall, in David Hume’s immortal phrase, stillborn from the press. Few will engage with — even bother to reply to — my argument because it is all out of tune with the spirit of the age. This column will be glanced at, and shelved.
But anyway, here goes.
Britain is on the brink of a grave misallocation of resources.
In scale it matches the error made when, after the Second World War, we resolved so to outspend our continental allies on defence that we choked our postwar economic recovery for a whole quarter-century: crucial years when the United Kingdom was left industrially trailing while Germany, France and Italy roared past us. And for what? A military edge which was never going to be more than pitiful by comparison with that of the United States.
Think of that time: much of our Army in Germany — staying for years beyond the military logic of a burden which should anyway have been more widely shared. Nimrod, Blue Streak, TSR2, Polaris, Trident, the European Fighter Aircraft — massive investments, some of them on a near-crippling scale, for benefits which have ranged from the disputable to the downright comic. And all of this as downpayment towards the great white hope of international pre-eminence which, now that the Americans have disposed of the Soviet Union with but marginal need of British help, appears in retrospect to have been a great white elephant.
Substitute prospect for retrospect. The next great white elephant has been chosen. It will be the National Health Service. The Chancellor, the Prime Minister, virtually the whole British political establishment, and the entire media chorus from broadsheet thunder down to tabloid tinkle, have gone collectively bonkers. Here the Government is, promising an increase of virtually 50 per cent in spending on what is already by far the costliest of all the State’s institutions — and we are all cheering.
Why? I am still finding the silence of the accountants hard to credit.
Think of all those years in the Eighties, years in which the eggs were being laid for the jamboree-smash into a statist omelette now merrily promised by Tony Blair and Gordon Brown; years when cuts of 2, 3 or 5 per cent — mere shavings from the edges of government spending — raised howls of protest as if the world were coming to an end ... and now this! 50 per cent. I wander, as in a daze, mumbling that figure. And nobody questions it.
Get a grip on the size of what is being undertaken: that within the space of about a decade we should have moved as a people from spending about 5 per cent of our GNP on doctors and pills, to nearly 10 per cent. Do you suppose that will be without effect on the remainder of economic activity in Britain? Without effect on what we have left to spend on other goods? Without effect on our competitive edge over the Asian economies now challenging our predominance?
If you had a private health insurance premium of £500 a month to pay, as did my father until recently he saw the light, and your health plan managers wrote to you and said that in the next few years it would rise to £750 a month and that over a decade premiums would have doubled, would you cheer? Would you rush to your nearest opinion pollster crying “let us give praise to our health providers who are now to spend so much more on us than before?” And if your health provider added to his demand note a PS, “Don’t worry, we’ll check it’s spent prudently and not frittered away,” would you say, “Oh, that’s all right then”?
Have you not noticed which two professions — priests and politicians — trade on the promise of eternal life? And have you not reflected on the truth that there is nothing like the fear of death to cause a layman to place undue trust in the promises of strangers, and part with his savings in the uncertain hope of a return in this world or the next?
Should you not — before falling on Gordon Brown’s neck and sobbing with relief at his pledge to relieve you of a great deal more of your wages so that he can be popular and you and your children can live longer — read what Warwick University’s Professor of Economics, Andrew Oswald, demonstrated on this page on Wednesday with a veritable battery of facts and figures? “Across the industrial countries,” Professor Oswald wrote, “there is no link at all (my italics) between the number of doctors per head and the length of life.
“According to the patterns in our most reliable statistics, a greater number of doctors in a nation does not bring about one day’s greater longevity for its citizens.”
In Italy, Professor Oswald points out, there are 550 doctors for every 100,000 citizens. That is three times as many as in Britain. Average life expectancy in Italy is 72. Average life expectancy in Britain is 72. In Belgium there are 400 doctors per 100,000 citizens. Average life expectancy in Belgium is 71.
But of course the Chancellor is not promising to spend all that extra money on doctors alone. Huge increases are also promised for hospitals, and hospital equipment.
Is this largesse the right way to start? NHS operations are not carried out at weekends because NHS consultants do not wish to work in NHS hospitals at weekends. Here is a massive improvement in output, with all the reductions in waiting lists and waiting times it entails, which could be secured without buying a single item of new plant or equipment. But a Health Secretary with money coming out of his ears is unlikely to wield much of a stick with consultants, who will now expect to be bribed. So will everyone else in the health and pharmaceutical sector. For the next five years, as the infrastructure of health struggles to digest this tremendous dollop of taxpayers’ treacle, the whole industry will be awash. Look at the fate of Nigeria after they discovered oil. It will be treble-Mercedes all round at Glaxo.
And, even if Professor Oswald is wrong to argue (as I, too, argued on this page ten weeks ago) that as a nation grows richer, cleaner, warmer, dryer, and better nursed and fed, extra billions on health suffer the law of diminishing returns, what confidence should we feel that what is fed in at the top from the Treasury will emerge along the bottom line of real new healthcare? Does anyone honestly think that a barking pack of “watchdogs” at the Treasury is going to be able to shepherd each new five-pound note through the paddocks of outstretched palms at the Department of Health, the hospitals, ambulance, nursing and GPs’ services, and the marbled boardrooms of GlaxoSmithKline, and all the way to the hospital trolley at the other end?
If only a fifth of this new money makes it through the system into real healthcare, a journalist colleague wrote recently, “we will see the difference”. A fifth, I reckon, is about the measure of it. I genuinely believe that such is the Prime Minister’s thinking: “For Pete’s sake, lads, if we chuck a sufficiently fabulous amount of money at health, some of it’s bound to get through even our appalling health bureaucracy, and make a bit of a difference before the next general election.” What a way to proceed.
Mr Brown says his Treasury boys and girls will “see” that the money is effectively spent. So what if it isn’t — what if civil servants find themselves unable to certify to their master that his money is producing the right results? Is he going to cancel the money? Will there be a statement in the Commons by the Chief Secretary to the Treasury: “Sorry, the Department of Health can’t have the money after all”? Is it imaginable that the failure of extra spending to “deliver” hoped-for healthcare improvements would cause the Government to cut the spending? Surely the reverse: there would be calls for even more.
Soon Lord Birt, No 10’s “blue skies” thinker on transport strategy, will tell Mr Blair what the Prime Minister hardly needs to look into the pale blue yonder but only through the steel fence at the end of Downing Street to see: that the required strategy for transport is quite simple. We need more of it. More railways, more Tube lines, more motorways, more bypasses, more relief roads, more trams, more tunnels, more bridges, new road-tolling systems, more bus lanes, free buses.
The Prime Minister will thank Lord Birt for his views, and shelve them. The necessary resources are already spoken for. On transport, a tenth of such resources would free up the clogged arteries of an entire national economy, but instead the whole lot are to blown on the NHS, where they will never be heard of again.
Five billion pounds spent on a decent transport system for the South East of England will do more, more quickly, to lower more citizens’ blood pressures than £50 billion on National Health Service coronary care services.
This is an epoch-defining blunder, and nobody is listening."