An unjust NHS for an unjust society

Anyone looking for improvements in the physical and mental health of the UK population — a task to which the government, with its Health of the Nation strategy, has publicly committed itself for a number of years — will have been concerned by the disturbing findings of the Joseph Rowntree Foundation Inquiry into Income and Wealth, published in February.

The inquiry team found that the gap between rich and poor is now greater than at any time since 1945. Income inequality in Britain has grown faster than in any other comparable industrial country, so that the richest ten per cent of the population now owns 50 per cent of the country’s wealth.

Whether or not such indicators of material inequality are regarded as objectionable, or simply as a fact of life in a market economy, there is a clear and well-established health cost to such growing disparity between rich and poor. Those 10 per cent of British households who lost out, in absolute as well as relative terms, as a result of the ‘economic miracle’ of 1980s Thatcherism, are now paying for the greater prosperity of the rest of us not only with their money, but with their lives. The costs to the poor of national policies which have systematically made them poorer can be measured very simply in terms of excess heart attacks, strokes, chronic disease, and premature deaths.

This price is paid through ill health and excess risk of injury and disability, not just by the adult ‘undeserving poor’, but by babies and children and by the aged, from the first hour of life to the very last.

Indeed, the health consequences of income inequality are now so salient that they are in danger of becoming a serious political embarrassment to the government. The Chief Medical Officer of England is concerned enough to have asked the NHS Centre for Reviews and Dissemination to look into effective ways to reduce the ‘variations’ in health which result. Thus we have the depressing spectacle of the country’s most influential advocate for the public health ignoring the most straightforward possibilities for prevention in the search for a cure.

More alarming still is the news that, while it is the NHS which everyday has to find solutions for the health impact of income inequality, it is now also becoming a part of the problem.

Recent revelations over management pay in NHS trusts, as reported on page 4 of this issue, suggest that the NHS may be set for the kind of boardroom pay scandals which, until now, have been the sole preserve of the private — or newly privatised — sector.

When the board of an NHS hospital decide to double the pay of their chief administrator to nearly £100,000 while rewarding patient care staff with a £5 Boots voucher in recognition of their efforts, we can ask for no clearer indication of how far the NHS has travelled down the road to privatisation. While the pre-reform NHS may have had many faults, such gross inequality between the incomes of administrative and front-line staff would simply not have been tolerated while the idea of the NHS as a public service was still strong.

For nearly half a century the NHS has represented a significant part of our national life in which need, rather than greed, has been the defining force. It is one of the saddest outcomes of the ‘reforms’ that this ideal seems now to be on the verge of extinction.