That's the question Newsnight is asking in tonight's programme.
"Not even 10 more years, however sentimental we feel. Society has moved on. A bureaucratic, tax-based system inevitably leads to the old being subsidised by the increasingly overtaxed young. This is just not sustainable.” So says cancer specialist and advocate for reform Karol Sikora in yesterday's Observer (not on-line).
Generational equity is certainly part of the equation. We also need to add demographics, in particular baby boomers, care of older people, dementia, obesity, the costs of technology and treatment, consumerism and ever-increasing expectations into the mix. See here and here for more on all this.
The NHS is the Conservative Party's number one priority. So said the Party in last week's Green Paper, calling for a focus on outcomes (e.g. cancer survival rates) not process-driven outputs (e.g. waiting times) and smarter data collection. These are necessary reforms. But, whilst certainly not marginal, they don't really cut to the heart of it. The pressures are immense, and the NHS as it currently is structured is simply inadequate to cope with what is coming.
Yet the Party has made the strategic decision to take health quietly in the first term. Schools, welfare and family are its "reform priorities." We may say that health is our number one priority, but our radical energies are going to be directed elsewhere. There might be some political attraction in that for now, but we cannot simply park health and social care in the hope that all will be well. We may get away with it for a while. But, if we are going to spend any more than one term back in power, we will certainly need to use that first term to start making some fundamental changes to the way our health and social care services are organised. We shouldn't brush this aside as being about pointless re-organisations. We need to face up to this now, not wait until a 2014 or 2015 general election.
Let's take accountability for example. An unelected NHS Board won't increase accountability but reduce it. When resources are limited, priorities need to be identified and choices made. The only accountable way to do that is bring decisions as close as possible to the people who are affected by them: locally-elected health boards and vouchers, personalised budgets are the levers to make that happen.
