No MS on the NHS

Daily Telegraph, 22 June 2000

THE preliminary recommendation by the National Institute for Clinical Excellence that beta interferon should no longer be prescribed for multiple sclerosis sufferers may ostensibly be based on clinical considerations, but it does not look that way. It looks, to the layman, as if it is mainly intended to save money.

Why else suggest that current patients should continue to receive the treatment at a cost of £10,000 a year, but those who contract the incurable disease after a certain date should not? Can this really be related to clinical excellence? In the Commons yesterday, Tony Blair said that NICE will end the lottery of "postcode prescribing" by imposing uniform rules across the country. But, in this instance, that is tantamount to saying that if everybody cannot have a particular drug then nobody can.

So much for the World Health Organisation's conclusion this week that while our health system may rank only 18th in the world, at least it is one of the most egalitarian. Maybe, but in so far as there is still a rough and-ready equality about the NHS, increasingly it is the equality of misery. Going into hospital today is rather like getting a telephone installed before privatisation. Unless you know how to jump the queue you have to wait for months, or even years. Worse still, if your disease is a serious or expensive one, it may actually count against your chances of getting properly and fully treated by the NHS.

Yet Labour, which now says it embraces privatisation, remains deeply reluctant to acknowledge that private health care could help resolve the crisis in the NHS. Health, it thinks, is too important to be left to the presumed vagaries of the private sector. Ironically, however, that is precisely what is happening as the NHS declines. Peripheral areas such as dentistry and spectacles were long ago left to the private sector. Now, the only drug available for multiple sclerosis may be confined to those who can pay. How does the Government reconcile this with its determination to uphold a completely public health service?

More money is promised, but it will take more than money and better management. The very structure of the NHS needs to be radically overhauled. No other sector is still centrally run as a 1950s-style nationalised industry, largely by ministerial diktat. But the Prime Minister, who is so keen to be seen as a moderniser, rejects any notion that the fundamentals of the NHS, and the principles on which it is based, needs to be modernised.

Instead, Mr Blair persists in claiming that the only alternative would be to follow the allegedly "private" model of the US. That, though, is false, and as a professed admirer of Europe he must know as much. For on health, many European countries have succeeded in steering at least something of a "third way" (to coin a phrase) combining private and public provision. By involving companies, charities and the voluntary sector to a far greater extent than we do, other countries have achieved genuine mixed provision. And that, in turn, has enabled them to call on far more varied and flexible sources of funds than we can in Britain. Here, the NHS has to look to the Treasury for virtually all its money.

Health, in fact, is one of the few areas where there are useful reforming lessons to be learnt from Europe. If this supposedly modernising, pro-European, third-way Government is to have any hope of tackling the NHS crisis, it must take its head out of the sand, and study them.