Hospital waiting lists and the future of health and social care services here have been one of the most covered news topics in recent weeks.

Unfortunately, many of the discussions, the radio phone-in shows, the newspaper columnists, the letters to the editor and the contributions in the Assembly have generated more heat than light.

We are probably less informed now than we were at the start.

Founding principles

However, several things are clear. There needs to be an informed public discussion about the future of our health and social care services, there needs to be a re-affirmation of the founding principles of the NHS – that it is a public service, publicly funded and free at the point of delivery, and there needs to be a clear and unambiguous declaration that health and care are human rights not opportunities for profit and financial gain.

Any discussion of the future of services might start by asking “are we running a Health service or a ’Sick’ service”? Currently nearly all our efforts are directed to treating people when the become ill, not on trying to ensure that more people stay healthier for longer.

When we talk about the health of the population, we can’t restrict that to a debate about hospitals, nurses and doctors.  If we are to help prevent more people becoming ill in the first place then we need to be talking about redirecting resources and looking at the impact of a poor environments, housing conditions, job opportunities and working conditions, improved educational attainment, information on diet, opportunities to exercise and avoiding and relieving stress.

How much would a four-day working week contribute to a healthier and less stressed population?  The causes of ill-health, not just the cures, need to be up front and centre in any and all discussions.

Traditionally we have thought, and been encouraged to think, that health was exclusively about hospitals. Much more care and treatment in the community and in people’s own homes is now possible and preferable thanks to new working practices, more developed skills and modern technologies. Developing that must be on the agenda, as must the source of any opposition to its extension. 

Some other issues are blindingly obvious. If dozens of hospital wards and hundreds of beds are closed down if the number of nurses in training is cut dramatically and funding is consistently cut, then there are going to be problems and there are going to be longer waiting lists.

We currently spend less per head of population on health services than France, Germany, Belgium, Denmark, Norway, Finland, Austria, and of course Cuba.

Shaping the narrative

In the past twenty years there have been at least four major reports proposing various levels of change to local health and social care services. 

The most important one has yet to be written. That one will recognise the social function provided by a public health and social care system, it will acknowledge the political agenda which, since the foundation of the NHS in 1948, has sought to undermine it, privatise it and profit from it.

It will concede the role that capitalist working practices and over production have on our environment and our health. Socialists, trade unionists, progressive thinkers and all those committed to a better and radically different future, need to start shaping that narrative now.