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Editor’s View: Shake-ups or milkshakes – take your pick

The debate over the future of healthcare funding shouldn't descend into playground hysterics
Health Insurance & Protection Editor David Sawers

It might have passed you by as it was a rather low key affair, but last week the President of the United States, Donald Trump, visited the UK on an official state visit.

While the inevitable shouts about “we shouldn’t roll out the red carpet” for President Trump were, erm, rolled out by the usual suspects, there were also people hard at work making, marketing, packaging, delivering and selling milkshakes.

And yet as the President was welcomed by the Queen, some of those milkshakes were not drunk and enjoyed, but tossed left, right and centre (well, tossed centre and right), as the rage boiled over from protestors demanding, among other things, that President Trump and US companies “keep their hands off Our NHS”.

President Trump was asked at a press conference if healthcare would be “on the table” in any future trade negotiations between the UK and the US. He followed up a somewhat nonchalant “everything is” answer a day later with a qualification that the NHS itself wouldn’t be up for negotiation – just the provision of products and services to it.

It’s hardly news. After all, it’s almost two decades since Alan Milburn, a Labour Health Secretary – yes, a Labour one – signed a Concordat with the independent healthcare sector, opening the door to extensive private sector provision of services to the NHS.

Stating that “There should be no organisational or ideological barriers to the delivery of high quality healthcare free at the point of delivery to those who need it, when they need it,” the 2000 Concordat kicked off an era, still alive and kicking, where the NHS turns repeatedly to the private sector to clear waiting lists.

That Concordat would be “the start not the end of a more constructive relationship [with the independent sector]” and the “NHS would now explore the potential for further collaboration with the private sector in such areas as pathology, imaging and dialysis, and join the NHS in commissioning research and development in ‘new centres of excellence'”.

The arrangement means that today one in every fourteen operations carried out on behalf of the NHS is performed by the private sector.

So, almost two decades have passed and the independent sector is still quietly going about its business, treating people that would otherwise be stuck on a NHS waiting list in pain, discomfort and frustration.

Not that any of that matters, though, as we are now in the era of the milkshake. We reached peak-milkshake during President Trump’s visit when a pro-Trump protestor was surrounded by a mob of angry protestors, one of whom (an adult) threw a milkshake (brand not yet known) at him (a semi-retired grandfather). Things had taken a turn for the sillier, if that was even possible.

Alongside this particular milkshake tosser was a lady snarling at the President, calling him “Nazi scum”. Ironically, that lady – you couldn’t make it up – worked for a private company that provides services to the NHS.

But after an equally thick-headed campaign from pro-Trump fans involving the obligatory online petition – there always has to be a petition these days (it only takes a click after all) – the lady in question issued a grovelling apology on Twitter, then deleted it, and then resigned from her job.

Quite how we got into this ridiculous situation remains beyond reason. Screaming “Nazi!” at people that aren’t, well, Nazis, is obviously absurd; but so is being hounded out of employment, as this lady was.

Then there was a sudden calm, as President Trump left the UK, with the streets of London and other cities across the country strewn with childish placards and puerile rubbish dumped by carefree protestors, and most people getting on with their lives in a state of apathy or bemusement. The President hopped onto Air Force One at Southampton Airport as it waited patiently on the runway, just behind the next Easyjet flight to Alicante, and off he went.

So, post-milkshake, where do we go from here? Some would like to see absolutely no US involvement in healthcare provision or funding in the UK. Ironically, they are often reluctant to “buy British” while also putting forward impassioned pleas to defend the rights of healthcare staff from overseas (yes, even those from the US) to work in the NHS. They also clearly buy milkshakes from, erm, certain large US fast food chains. Burger King’s attempt to capitalise on the milkshake madness – a special offer in Scotland was tweeted out during the President’s visit by the fast food giant – was crude but quite apposite.

Equally, though, the more extreme free marketeers would like to dismantle the NHS altogether and implement an unadulterated US-style insurance model. The idea of that kind of overnight fix is for the birds.

And yet I still don’t know who is right. But I do know that the private healthcare sector, including US firms, is more than willing and able to co-operate with the public sector to improve healthcare outcomes for the entire – yes, the entire – population. Is working together such a bad thing? And is even talking about it off limits? Two decades after the Concordat was signed, it seems to be.

But the binary choice of either/or is also for the birds. We live in a mixed, global economy and moving to a straightforward US model and getting rid of the NHS altogether would be throwing the baby out with the bathwater. Equally, pinning unicorn hopes on a wholly public sector solution with unlimited, poorly managed finances, is futile.

I was hoping that the visit of President Trump might have opened up a rational debate about the future of healthcare funding in the UK. It didn’t. It just ended up in adults throwing milkshakes at each other.

In an equally unedifying spectacle, the candidates for the next leadership of the Conservative Party – and therefore the next Prime Minister – have all been desperately elbowing each other out of the way in an undignified, even cowardly, scramble to proclaim that the NHS is “not for sale”.

Of course it’s not. But isn’t there room for a debate about funding and provision? Apparently not, even in the eyes of potential Prime Ministers who believe privately that healthcare provision and funding in the UK is in need of a radical overhaul.

It’s illogical; US healthcare providers and insurers are here already. If anything, they are a threat – or perhaps a welcome challenge – more to incumbent domestic private medical insurance providers than to “Our NHS”. Refusing to have a dialogue with them is foolish.

Not only that. Throwing milkshakes at them is also doltish and embarrassing.

And a decadent waste of milkshake.