Cuts? No, change the terms of the debate
Published in: Daily Mail
A ghastly blunder at an NHS fertility clinic has left two sets of prospective parents devastated.
A couple who had already produced one son through in vitro fertilisation decided four years later to have another child by using the last viable embryo of nine which had been created and which was stored at an NHS clinic in Wales.
To their horror, they were told that through a clerical error this embryo had been implanted in the wrong woman's body -- and aborted as soon as the mistake was discovered.
It is said that staff at this clinic had been struggling with an enormous workload. But this was by no means the only such debacle in NHS fertility clinics.
New figures due to be published this summer will show around 200 serious mistakes and 'near misses' in such clinics. Such blunders deepen doubts not merely about standards at the Human Fertilisation and Embryology Authority, but about IVF itself.
There is no question but that it brings great happiness to otherwise childless people whom it enables to have a baby. But it has also raised a host of ethical issues that have multiplied and remain unresolved.
Many find it distasteful and troubling -- to put it no more strongly -- that because it is so difficult to implant an embryo successfully, more are necessarily created than will eventually become babies and so the majority are eventually destroyed.
Creating potential babies in this way only to dispose of them has undoubtedly helped erode respect for human life.
The procedure has also led us into the ethical quicksands of embryo research and 'designer' babies, not to mention in some cases breaking the biological link between parents and children and enabling other women to have children without a father being around at all.
More sharply still, for most people IVF simply doesn't work. Almost three-quarters of those who put themselves through this trying procedure will not end up with a baby. By raising their hopes only most cruelly to dash them, IVF must surely deepen their anguish.
True, much IVF work is done privately. But given all these concerns, the question is whether it should be funded by the taxpayer at all.
That may sound harsh for those who do have IVF children on the NHS. But in a service with finite resources and where provision is always rationed in one way or another, choices inevitably have to be made about what the NHS should provide and what it should not.
After all, the NHS is a health service, not a happiness service. So where should the line be drawn? At what point does clinical need turn into 'what I want' instead?
Is it right, for example, that the NHS should pay for gender reassignment or gastric band operations for those who cannot -- or will not -- lose weight by conventional means?
Such questions are especially acute now. For despite the attempt by Gordon Brown to pretend that the Government will not make cuts in public services, it is clear that this is indeed the case.
As the respected Institute For Fiscal Studies has pointed out, the Government's own spending plans envisage that from 2011 there will be cuts of around 7 per cent over three years.
Remarkably, Mr Brown is brazenly denying these statistics even though his own Government has produced them. He is doing so because he thinks that tarnishing the Tories with plans to cut public services such as health and education is one of the biggest weapons in his electoral armoury.
So he will challenge them to say whether they will cut teachers or nurses, or to spell out what NHS treatments they will stop funding.
But this tactic is not only cynical and dishonest: it is fatuous. Asking what public services either Labour or the Tories would cut is to pose the wrong question.
That's because central government should not be making such decisions in the first place. It is wrong for a politician or some Whitehall bean-counter to say people can't have IVF or the latest drug to combat Alzheimer's.
Whether or not these things are efficacious or worth the money is a calculation central government should not be making. It should be no business of the state to tell us what treatments we can and can't have.
But as long as the Government controls the purse-strings, it is entitled to make up the rules. What's wrong is that it does control the purse-strings. It's our money, and we should be entitled to decide how to spend it.
For we now know beyond a shadow of a doubt that the Government cannot be trusted to spend it properly. We know about the serial computer debacles.
We know about the huge profligacy and waste, with the idiotic non-jobs of 'diversity outreach co- ordinator' and such-like.
We know that in both health and education, gazillions have been poured straight into a black hole. We know that, while the extra money has undoubtedly brought about some improvements in the NHS, most of it has been wasted.
As for education standards, we can see them slipping as we hear ministers lying through their teeth that they are rising. And the most heavily funded state schools are often the very worst.
What the current crisis surely tells us is that this is now the time to stop prattling meaninglessly about 'cutting waste' and 'increasing efficiency' and address the root of the problem.
The era of paying central government to deliver public services such as health and education should be declared to be over.
We should start with a blank page on which should be written two fundamental principles: that the public should be put in the driving seat, able to choose what type of services to have and to take responsibility for those choices; and that the poor should be protected, so that all have access to a decent level of provision.
These principles would play out differently with different services. Personally, I favour some kind of European-style social insurance scheme for health and long-term care, and education vouchers to give all parents a proper choice of schools.
In countries where such schemes are in use, standards for all in both health and education are vastly higher than in Britain.
With our current system demonstrably bust, this is surely the moment to start a serious debate on these matters. But on all sides, politicians are unable or unwilling to tell the public the truth.
By denying what his own economic policy means, Gordon Brown is treating voters like imbeciles. But the Tories are scarcely any better. When Shadow Health spokesman Andrew Lansley let slip that, like the Government, the Tories would also be forced to cut public spending, his leader apparently rewarded him for his honesty by a roasting.
The Tories are still terrified that they will be painted all over again as the 'nasty party' if they acknowledge that the game is up for the NHS and other public services. So they are effectively colluding with the Government in the spending charade.
But times have changed. Everyone knows that whoever wins the election will have to make cuts. The new issue is that the public will no longer tolerate being lied to, about this or anything else. They are demanding honesty and transparency in political life.
And that means an end to the illusion that everyone can have identical access to everything -- from IVF to 'gender reassignment' -- at all times.
It means an end to this puerile politics of the playground. Now is a golden opportunity for the Tories to seize the agenda -- along with their courage -- and change the terms of the entire debate.