Each week Prospect asks experts, and our readers, to come up with answers to the questions dominating the headlines.
This week, the NHS has dominated the political debate: on the one hand, David Cameron and Health Secretary Jeremy Hunt have piled pressure on Ed Miliband for his party's alleged failings on the NHS in Wales. On the other, Labour have seized on former Blairite advisor Simon Stevens's 35-page new plan for the NHS as an endorsement of their criticism of the current government's troubled relationship with the health service. The NHS is clearly struggling, but who has the cure?
Wean us off junk food
In Simon Stevens's three-point masterplan to save the NHS—extra billions, modernisation of what care involves and his "radical upgrade in prevention and public health"—the last one is by far the most difficult, but also the most important. Smoking and drinking produce horrible diseases and heavy costs. But unprecedentedly interventionist action on obesity must happen to stop the tsunami of lifestyle-related illness overwhelming the NHS. The obstructionist "nanny state nonsense" brigade must be ignored, the public forcefully, regularly reminded about their responsibility to their own and their loved ones' dietary health, and ministers emboldened to do whatever it takes to denormalise unhealthy food and wean us, the fat man of Europe, off our reflexive intake of junk food, by either persuading, shaming or incentivising us to do so. Denis Campbell, Health Correspondent, The Guardian
Restore public ownership
The first thing is to end all subcontracting to private contractors, even the cleaning and the catering. This is partly a matter of principle—there's no reason that companies should make profit out of caring for our health. But it will also reduce the amount of bureaucracy in the service. All PFI contracts, which have been an absolute disaster, should be cancelled as soon as it's legally possible with the minimum expenditure. The aim, ultimately, has to be to remove private healthcare altogether. Everyone's health should be valued equally: the idea that some people's health has to take priority over other people's health and wellbeing is abhorrent. Ken Loach, Film-maker
Boost social care
At next year’s election, there needs to be a proper debate about what kind of health and care service the country wants. After David Cameron’s £3bn NHS re-organisation, A&Es are in crisis, waiting lists have hit a six-year high and cancer patients are waiting longer for treatment. A Labour Government would repeal his Health Act. When the ageing society demands greater integration of care, markets deliver the opposite. Labour would bring social care into the NHS to build a service that starts in people’s homes and gives them a single point of contact for all their care needs. Andy Burnham, Shadow Health Secretary
Bring back competition
Competition and choice were once at the heart of health reform. Today competition is the most hotly contested word in the politics of the NHS. So much so that Simon Steven's landmark review for NHS England did not mention it once. This seems at odds with what we know of Stevens, an architect of Labour's reforms which expanded the role of the private sector to increase capacity and choice. In other health systems and other industries, competition is a vital driver of efficiency and innovation. In the face of rising demand and shrinking budgets the NHS must now embrace competition. Cathy Corrie, Senior Researcher at the Reform Think Tank
A political amnesty
If we are going to ensure our grandchildren have an NHS free at point of need (which is different from free at the point of people’s ever-increasing demands on it) politicians are going to have to face some difficult questions; questions that have previously been put in Charles Clarke’s "too difficult box." Questions that few politicians have been brave enough to ask for fear of the opposition rabidly misrepresenting them as wanting to eat babies for breakfast and killing the NHS. We need a political amnesty, and manifesto building based on a core of consensus. Radical? Yes. Needed? Absolutely. Charlotte Leslie, Conservative MP and member of the Health Select Committee
This week's Big Questions is edited by Josh Lowe and Alexander Brown
Reader responses
@prospect_uk to charge for 'did not attend' appointments. £ms wasted every year because people don't turn up
— Oli Griffin (@OliGGriffin) October 24, 2014
Well, @prospect_uk, perhaps something to counter stream of "NHS is useless" diatribes in the media?
— Gram Joel Davies (@poplarist) October 24, 2014
@prospect_uk How about a serious discussion on Tax? Surely if we want the best we're going to have to pay for one anothers care #community
— David Wilmot (@davidmwilmot) October 24, 2014
