Dani Garavelli: A two-tier NHS can never be the answer

There’s a phenomenon I witnessed recently where elderly people suffering from dementia ordelirium start fixating about money. Sometimes they become convinced they have millionssquirrelled away under the floorboards. Sometimes they accuse their nearest and dearest ofstealing from them. And sometimes - if they are in hospital - they fret about how they will paytheir medical bills.

Hospitals under strain

It can be distressing to watch their anxiety mount as their frailty grows. But,

always, doctors and nurses are there to reassure them. “This is the NHS,” they say. “You don’t

have to pay.” Although, obviously, they have already paid. Via their taxes. All their working lives.

Though I am no psychologist, I suspect this anxiety is rooted in the past. Few of those receiving

treatment right now will remember life before the NHS; but they may recall their parents talking

about a time when healthcare was patchy, and illness took a heavy financial as well as physical

toll.

Former health secretary Sajid Javid has a hankering for those bad old days. Last week, he said

the “unsustainability” of the NHS should be tackled by charging patients for GP appointments

and A&E visits - a suggestion that undermines the founding principles of the NHS and gives the

lie to those who have dismissed warnings of privatisation by stealth as “scaremongering.”

Javid affects to believe NHS problems are being caused by the frivolous accessing of services

by people who take them for granted. Prime Minister Rishi Sunak says he is not “currently”

considering his suggestion. But a shared belief in patient profligacy was at the heart of his own

proposed introduction of a £10 fine for missed appointments - a policy dropped when it was

pointed out most repeat offenders are not affluent timewasters, but people already on the

margins.

That the NHS is gubbed is obvious to anyone who has been paying attention. Barely a day

passes without another horror story about backlogs in vital operations and months-long waits for

urgent tests, while elderly people languish in wards for lack of anywhere else for them to go.

It is true most GP practices have their “frequent attenders”, and some people do make

unnecessary visits to A&E. But these factors are negligible compared to the principal drivers of

the NHS crisis: demographics, the pandemic, the failure to recruit and retain staff, and, perhaps,

most importantly, the failure to address the crisis in social care.