MEDICINE
Wanted: a
dose of money
JOHN ROWAN WILSON
Whatever issue looms largest in the elec• tion, one can be pretty confident that it won't be the National Health Service. We are hearing something about doctors' pay; but ever since Mr Bevan's Act twenty years ago, a great coyness has descended on our poli- ticians when it comes to discussing the future of medicine in this country. They are happy enough to let themselves go on the subject of Rhodesia or the price of butter or the South African cricket tour—but when
it comes to a service which costs the country over a thousand million pounds a year, they have little constructive to say.
Can this mean that they think all is well? It seems hardly likely. While it is true that Ministers of the Crown are themselves rarely exposed to the full ghastliness of our anti- quated hospital system, they must surely have observed it in the course of tours of inspection, or while passing to and from the private rooms in which they customarily receive treatment.
But to get down to the deeper springs of a politician's behaviour one always has to start thinking in terms of votes. Certainly the idea has grown up that there are no votes in the health service. While no doubt every- one would like to see it improved, it is obvious that to make any important change would require money. The Conservatives are committed to keeping taxation down; and while the Socialists are in favour of taxation, they like to use it in ways which have more chance of buying electoral support.
Yet the necessary money could in fact be obtained without increasing taxes, if only the politicians were prepared to take their blinkers off for a moment. One of the rea- sons why people working in the health ser- vice get so exasperated when they receive lectures on financial stringency is that they can see money spent so lavishly and foolishly elsewhere. It is not difficult to find areas of government where the application of a sense of proportion would release the necessary funds to bring our medical services more in line with those befitting a modern state.
Prominent among these, of course, is the ridiculous Concorde project. Every conceiv- able justification for this drain on the national economy has long since vanished. It is no longer even pretended that it has any chance of paying its way, and it has signally failed to persuade the French into backing our entry in the Common Market. It is a cause of environmental pollution and the only benefit it can bring is to get busi- nessmen to New York an hour or two earlier. Might not the money be better spent in building a few decent modern hospitals?
And then there is the question of so- called higher education, on which money has been lavished over the last decade. I can imagine the sharp intake of breath from all the trendy progressives that anyone should dare to breathe a word of criticism of this. However, I can see no real reason why uni- versity education should be regarded as an absolute good, free from the analysis of cost-effectiveness and objectives which we apply to other forms of expenditure. It is surely reasonable for us to ask ourselves what we are getting back for the large amounts of money we are spending.
We are now training more historians, social scientists, political economists, and specialists in modern French literature than at any time in our history. To what end? I meet a number of these young people from time to time, and very delightful they are. However, few of them have any clear idea of what they propose to do after they have obtained their qualifications. Frequently they say they would like to teach history, social science, political economy, and all the rest of it to the next generation. The others are vaguely optimistic that some kind of interest- ing job will turn up. Perhaps in journalism or the BBC .
This might not matter if we were loaded with money and didn't know what to do• with it. Running a vast, elegant finishing
school at public expense is a pleasant form of extravagance for a rich nation. But it is a little unseemly for a country which is staffing its crumbling hospitals with doctors from Pakistan and nurses from Nigeria.
It is significant that nowadays even the daughters of doctors hardly ever seem to express a desire to go into nursing. Every schoolgirl knows that there is more money, more prestige, and more leisure in designing questionnaires about the health service than in actually looking after the sick. It is all part of the pernicious snobbery of the liberal arts education, which has now been insti- tutionalised by government money. I am not against the expansion of higher education. But I am prepared to suggest that forms of higher education which are manifestly important to the community, such as medi- cine and nursing, should take precedence. To spend our money on building ever more institutions for training redundant Arts graduates when our unfortunate mental defectives are still housed in almost mediae- val conditions, is a strange form of liberalism to my mind. Here, surely, is an area where a transfer of resources is long overdue.
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