There will never be enough money for the NHS.  With an ageing population and advances in all kinds of treatments, desired expenditure can only rise in real terms.  Unrestricted demand will always outstrip the resources that the tax payer can afford.  The NHS is a bottomless pit in terms of its cash needs. 

When the NHS was created it led the world, but was in the main it was just that – Health.  Now Mental Health and Social care are inextricably linked.

Never would I consider removing the NHS principle of treatment free at the time of need.  But, except for the accusation of jumping the queue, I do not see any problem with private treatment.  It is one procedure less to be funded by the NHS and if a private hospital can, say do a quality hip replacement for less cost than in NHS, so be it, it will cost the NHS less to send and pay for that patient.

So since the starting flag has dropped on public debate with the recent report on the massive cash shortfall in the NHS.  Everyone will agree that any rationing of treatment is difficult for all, emotional for many, possible life threatening for an unfortunate few and heart rending for their close family

As I say above the NHS is a bottomless pit in terms of its cash needs.  Money studies could be done to identify savings particularly in support services.  They can save money immediately by not being obliged to offer translation into a myriad of languages.  If someone is living here they should be able to function here in English.  If they are a visitor they will normally have a resident friend or contact here.  Multi-ethnic, multi-cultural does not mean multi-lingual when dealing with their daily lives outside of the family.

Where do the boundaries lie?

At one end of the social spectrum of conscience is the prolonging of lives of all ages, but especially for chronically ill babies and children, just because it is possible.  Charlie Gard is a classic example.  Why the authorities will not let him go to the US, the parents have raised the money, instead of the hard-pressed NHS squandering money on legal fees, equivalent to many hip replacements or transplants.

IVF for all, no matter if the woman has already had a child or children and/or where the parent/child age gap will make physical play with the child in its adolescent years difficult and communication gap may be more like grandparent to grandchild.  And what about the increasing demand for the resolution of gender issues.

Then there are those who after deep consideration wish to end their lives before their suffering becomes too great.  Euthanasia has the potential to reduce healthcare costs, so with the right safeguards, why not?

Keeping hopeless cases alive, with long court battles over Human Rights.  The costs of these battles reduce the money available for other, more routine cases.  They illustrate the complexity of the debate and the emotions it will certainly arouse.  Perhaps a new Court system needs to be established for litigation with the NHS that can be cheaper and somewhat more rapid.

So whatever rationing system is devised, I would see to it the preventative programmes and early diagnosis got a high priority.

However, all of us that have had cause to be grateful for the skills in the NHS, but will have seen that there is also much that can be done more economically.  These issues have to be attacked without excessive union obstruction.

And safeguards must be in place for the poor especially to keep them in work and those suffering with chronic disease that is not obviously self induced.  But reflecting why I put Education before Heath in my spending priorities there are those who do not look after their health.  Excesses of smoking, eating, alcohol and drugs can before it kills you involve huge demands for health services and indeed social care.

All this raises a debate on the value and quality of life.  How much research should be done for a rare condition, compared with common afflictions?


Pension and Unemployment benefits remain unchanged.  Although I have sympathy with the need to restrict universal benefits regardless of need, such as the Winter Fuel Allowance.  However I suspect the cost of assessing the need will outweigh the savings involved, unless it was totally stopped.  Unemployment should be supplemented by free travel to job interviews or training.

Disability benefits need to be provided as generously as the States finances allow.  Each case should be assessed to comprehensive rules and time related.  These should be

  • ·         Applicant must Be British
  • ·         Genuinely cannot work
  • ·         If not unable to work, is he/she genuinely seeking work with assistance, including financial, to seek work
  • ·         Then what is their need
  •           If so, for how ling and that is the time limit set.         

If the recipient is never going to recover do not bring them back every year, although the continued existence of the condition needs checking.  If however all might change in 6 months then that is the limit set, and the recipient will need to reapply.

Then there is the political hot potato of a Benefits Cap.  There has to be one.  First because a benefits recipient must not receive more than someone in work.  Second because the funds of the State are not unlimited, so a cap must be set with the suggested new BASIC Cost of Living Index.  See section 7.4 (More Babies) and section 8.