We often talk about the NHS as being ours, but what does that mean? There are plenty of things we pay taxes for that we don’t regard as ours, at least not in the same way.
The NHS was set up as a universal service to bring quality and comprehensive healthcare to all, not just the wealthy or the privately insured.
We have to cherish the NHS - that includes a recognition that it is not there to give us whatever we want.
So it represented the widespread view after the Second World War that we should be supportive of each other.
Most people still feel that the NHS is there for them – especially those who have grown up with it for much of their lives, and the millions of people who are grateful for successful treatment outcomes.
You may be surprised to hear that it’s actually in law that the NHS is ours.
One of the few good things about the Coalition’s 2012 Health and Social Care Act was that it reinforced the legal status of the NHS Constitution.
The constitution was developed under Labour, which starts like this: ‘The NHS belongs to the people. It is there to improve our health and wellbeing, supporting us to keep mentally and physically well, to get better when we are ill and, when we cannot fully recover, to stay as well as we can to the end of our lives.’
Yet the NHS often doesn’t feel like ours: some of its habits of secrecy, defensiveness and old-style medical paternalism have not disappeared.
It doesn’t feel like ours when we can’t seem to access the help we want; and when parts of the NHS are contracted off over our heads to for-profit companies it ceases being ours at all.
If the NHS is ours what sort of responsibility do we, as citizens, have for the NHS? We have to cherish it – and that includes a recognition that it is not there to give us whatever we want.
But it also means that we have to challenge politicians who flinch from telling us that we do need to pay taxes if we want tax-funded services?
The UK spends less on health and social care than many comparable countries.
The Autumn Statement was a dismal day for health and social care.
The Prime Minister and Chancellor repeated the misleading Tory promise of £10 billion extra for the NHS.
It’s not just Labour who dispute this; critics include Conservative MP Dr Sarah Wollaston, chair of the Health Select Committee, and even former Health Secretary Andrew Lansley.
Social care, cut by at least nine per cent under the Coalition, despite growing demand, got no help despite its effect on the NHS – including an annual cost of £820 million for the delayed discharges of patients .
At the same time, local decision makers are being saddled with responsibility for £22 billion in ‘savings’ which are supposed to be achieved through Sustainability and Transformation Plans (STPs).
The local STP aims to bridge a government imposed funding gap of £571million by 2020-11.
It’s good that local health organisations are working together on arrangements and we can expect some genuine improvements.
But it won’t be good if the requirement to save money makes services more difficult to access or stretches staff, already on the rack, far further than they can go.
More scarily, the central authorities talk about ‘moderating the demand for healthcare’.
What does this mean? Many public health measures take time to show their effect.
Abuse of services causes understandable anger but only forms a tiny part of the problem.
The most likely methods of reducing demand include cessation of services, rationing and diversion and these have to be challenged.
Current proposals to centralise some services, for hyper-acute stroke and paediatric surgery, predate the STP and have different justifications.
However the STP hints heavily at wider hospital changes for future years.
We need to assert our rights by ensuring that all proposals for change are formally consulted on and fully discussed, especially if they are controversial or reduce services.
Proposals for reconfiguration which are mostly aimed at cost-saving should be rejected not just because they reduce the service but also because, as Dr John Carlisle told the SSONHS meeting highlighted in this newspaper last week, they will probably end up costing more in the end.
We cannot be expected to support local decision-makers agreeing the general direction of the STP, however attractively presented, only to find that they’ve signed away our rights in some unavailable small print.
The NHS can only be truly sustainable if it really is a citizens’ NHS. We need to play our part.
Look out for meetings on the STP plans for Sheffield, Rotherham, Barnsley, Doncaster and Bassetlaw.
Some will be set up by NHS agencies and some by local political or patient groups. Somewhere there may even be a discussion of the effect on South Yorkshire as a whole.
Get involved, because (for now) it still is our National Health Service.
The Sustainability and Transformation Plan, and the other consultations mentioned here, can be accessed by visiting http://www.smybndccgs.nhs.uk/ and choosing the relevant links.
SSONHS has a meeting to discuss the STP on Monday, December 5, at 7pm at the United Reformed Church in Sheffield city centre.