by Peter Watt
Yesterday saw the publication by NICE of their latest guidance on the use of IVF by the NHS. It said that women should be able to access IVF quicker (ie younger) and also that the upper range of women able to access the treatment rises from 39-42 in England and Wales. This has to be seen as a good thing, a reflection of the continued advances in medical treatment. What was in the past impossible becomes possible.
Except read the small print. What NICE are doing is providing advice to NHS Trusts as to what they can do if they choose to. As Dr Sue Avery from the British Fertility Society told the BBC:
“It’s good that there’s the possibility there, but the funding does not match. I can’t see any prospect of it happening immediately. Our biggest concern is hanging on to the funding we’ve got.”
Now quick declaration of interest here; my wife Vilma and I underwent IVF. Initially we had treatment on the NHS and then went privately. We were successful and have a beautiful daughter as a result. But at the time we were incredibly lucky that where we lived was still offering treatment on the NHS. Plenty of others no longer did or offered a much more limited service. Because the reality of the NHS is that on a whole variety of fronts it rations treatment.
On Tuesday there was a story about a man who had had a gastric band on the NHS but who was left with large amounts of excessive abdominal skin. His local health service had refused to pay for his apronectomy and he was facing a bill of some £15-20,000.
Or just think about the people refused cardiac surgery unless they lose weight or stop smoking. In some areas you can get some types of cosmetic surgery and in others not. In some areas certain services and procedures are available pretty quickly in others there is a longer period of waiting.
Across the Country there are debates about where maternity and A&E departments are sited with no area wanting to give up ‘theirs’ even though we don’t need as many as we have. In dentistry and optometry the NHS offers a fairly limited service by comparison to what is available privately. And all of that is before you get to the social care rationing which, depending on where you live, is contingent on what services you can access and at what point you are deemed weak enough.
Rationing in the health and social care sectors is a reality and has been so with increasing impact for many years. Politicians may decry the “post-code lottery” but it is a dishonest slogan. The notion that all decisions about what to deliver and in what way can be determined in Whitehall is clearly nonsense.
So over the years decisions have rightly been devolved; and if you devolve decisions then you should expect choices to be made! Now all of that was the case even when Labour decided to turn on the money tap.
Spending on the NHS has increased ten times since 1948. In today’s money we spent about £9 billion in 1948 and the 2012/13 budget is £108.9 billion. And labour massively increased spending so that from 1995 to 2006, the NHS annual budget more than doubled from £39 billion to £89.7 billion. Years of infrastructure underinvestment meant that the money was soon swallowed up. But it didn’t stop the rationing.
It certainly didn’t mean an end to the abuse and unnecessary deaths that the Francis report and others have exposed. In many ways, increasing spending that much and that fast without the requisite reforms of the NHS was one of the biggest mistakes of the Labour government.
As the Tories have shown, even pledging to ring-fence the NHS budget when other departments face cuts is not enough. An aging population and the onward march of technology, new drugs, treatments and staffing costs means that freezing the budget is an effective cut. If you then add in a need for huge efficiency savings then the results are there for all to see. But carrying on as we are is not an option. We simply cannot continue like this. At what point does the NHS have enough money? Is it £120 billion? £150 billion? But no one yet seems brave enough to say it.
Instead we get the doublespeak of efficiencies, local commissioning decisions and NICE. In government, Labour planned efficiencies and would not have ring-fenced the NHS budget. Now in opposition they decry the cruelty of the governments cuts. In opposition the Tories marched to save their local hospitals and slammed the government. At some point this has to stop.
People are not stupid whatever politicians may think. The only way that we can possibly begin to tackle the structural deficit in this country is to be honest with people about what is possible and about what is not. They can see that spending on some things will have to be curtailed and choices made. They can see that they will need to make some decisions themselves about their own lifestyles and priorities. They are quite capable of being part of a grown up discussion about this. But politically we don’t seem to be prepared to do this. We seem more comfortable demanding an end to the postcode lottery – until we are in government of course and it becomes local commissioning decisions again.
Peter Watt was general secretary of the Labour party