We were driving to a small village near Chania on the island of Crete. “Do you know where you are going?” asked my daughter’s boyfriend who was travelling with us for the first time and not wholly familiar with our ways.
“Rarely,” I said, “but don’t worry, we usually arrive somewhere.” “What if it is the wrong place?” he asked nervously. “We’ll burn that bridge when we get to it,” said my daughter and we all laughed. “Why are you laughing?” she said. “Because you said a funny thing,” her mother said. “Well done”.
“It’s not funny, it’s a saying,” she said.
“The saying is ‘we’ll cross that bridge when we get to it’.”
“That’s less dramatic.”
“Well yes, but it makes more sense.”
There was silence. “What about ‘storm in a teacup?’ is that a proper saying?”
“You’re just upset because you want to set fire to a bridge when we get to it.”
“How about ‘there is more than one way to skin a cat’,” she said.
“That’s a saying.”
It is. How do they know there are more than one way to skin a cat? Did they get a load of cats and skin them in various ways?
“I’d like to get out of the car now,” said her boyfriend.
“You can’t,” I said, “the bridge is on fire”.
“And we haven’t skinned the cats yet,” said my daughter.
If you wanted to replace the NHS with something regressive, the most obvious way involves announcing that using it would involve taking out insurance policies that would enable accessing different levels of care. £25 a month gets you a GP. £50 a month gets you a GP, two referrals, a moderate treatment package and 10% off a foot spa. £100 a month gets you a GP, surgery, scans, follow-up treatment and rehabilitation.
The trouble is people rather like the NHS. They know that for all its struggles, it is effective and reliable. So reframing it as a multi-tiered system will bring down whichever government tries to introduce it.
But if you skinned that giant NHS cat slowly, methodically and quietly – when everyone was looking at something else, like a giant space monster in the corner, or Brexit – you might just get away with it and open up a whole raft of new revenue streams for people who live for that sort of thing.
Arguably the cat should have made a run for it when we introduced competitive tendering. Normalising a process that encourages profit-making organisations to compete with trusts to provide NHS services was always problematic. Now we have politicians openly talking making the NHS part of future trade deals and health providers the world over preparing to share the soon to be corpse. Free at the point of access? Well it depends what you mean by free – and access and point.
The most generous thing you could say about austerity and the philosophical abandonment that accompanied it was that it was thoughtless, poorly planned ‘economics from misanthropes’. A less generous analysis would say it looks like a plan to take a decade or so to skin a cat. That you kill something by wounding it first, recurrently, systematically, until finally even the people who love it the most want it put out of its misery.
Paranoid? Maybe. Tell me an alternative future for the NHS to ease my – and the cat’s – mind. A realistic one, be kind and reassure me. Or better still, tell me how we became so collectively blasé about such a remarkable and precious institution.