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The Barker report provides some much needed rationality

Michael White
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With media energy focused on the Scottish referendum and the Ashya King story, Kate Barker’s report on a new deal for health and social care went under the radar – but it has many good ideas


“Keep Calm and Carry On” was a famous wartime slogan that has enjoyed a revival in recent years on postcards, t-shirts and mugs thanks to our thriving nostalgia industry. But far from merely being a good joke it’s going to be essential advice for most of us in the turbulent times ahead.

Not just over Scotland or Syria, both scary in their own very different ways, but in the uncharted road awaiting NHS structures and finances. The pro-NHS march from Jarrow finally reached Trafalgar Square last weekend (only 3,000 to 5,000 supporters in the square?) but it was overshadowed by a more modern health drama: how best to treat medulloblastoma patient Ashya King and his runaway parents.

Initial hostility to the determined but reckless Kings swung 180 degrees thanks to a smart social media campaign. It blamed heavy handed coppers and the family’s hospital in Southampton for offering the “wrong” treatment, conventional radiotherapy, not the proton beam therapy now promised in Prague.

Our hands-off health secretary, Jeremy Hunt (that man again!), popped up to dispatch a cancer specialist to smooth the way.

‘It’s part of political leadership to respond to public concerns, but also to stand up to media driven hysteria’

It’s part of political leadership to respond to public concerns, but also to stand up to media driven hysteria that sometimes devours public funds better spent elsewhere. What better cause than a child’s life, you may say, and you may be right. Let’s see.

Below the radar Barker

But I turned with relief to the calm rationality of economist Kate Barker’s report on a new deal for health and social care. It was published without much fanfare last week: media health energy was focused on Ashya’s story.

‘Charges for A&E of GP visits would be costly to administer and medically regressive’

Don’t be overimpressed by Barker’s credentials as a Bank of England adviser. Nobel prize winners have been giving dud advice on Scottish currency policy and Barker’s last big report, about UK housing problems, concentrated too much on supply shortages, not on other factors like the wrong sort of homes in the wrong places, let alone Russian funk money and second home purchases driving up prices in prime areas.

From what I’ve read, I like her NHS report better. It envisages NHS England gradually move to an integrated system (ticking Andy Burnham’s box) by 2025 with a ringfenced national budget and a single local commissioner. Social care would be free to the neediest, means tested elsewhere.

The good ideas

Being a grown-up, Barker says this will cost up to £5bn and that the NHS will be spending 11-12 per cent of whatever GDP is a decade hence. There’s no menu without a price list, so she proposes some tweaks, sensible enough but easier for The Guardian’s redoubtable Polly Toynbee to embrace than for Ed Balls. Barker says no to more charges, for A&E or GP visits, let alone fines for no-shows. Correct: they would be costly to administer and medically regressive.

No too to the health insurance model. Correct again. As pet insurance shows, it distorts behaviour and drives up costs.

She then comes after me. Not personally, but in saying prescription charges should be cheaper (£2.50?) and with far fewer exemptions, she has better off oldies in mind. Likewise with her old patron Gordon Brown’s voter bribes: free TV licences for over 75s and winter fuel payments for dukes. Curb this unfocused largesse.

Those over 40 should pay an extra 1 per cent on national insurance contributions. That makes sense as creeping mortality makes itself felt. Another 1 per cent for those earning more than £42,00 is trickier, many such people have just lost child benefit; we need them to buy into the welfare state. And 6 per cent NICs to be levied on currently exempt over 65s who still work. I shall stop typing immediately, but it’s not a bad idea.

Michael White writes about politics for The Guardian

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