There's no more NHS. There's an EHS and an SHS
There's nothing national about the National Health Service
As anyone will know who has witnessed the death of a relative from multiple myeloma, it can be a grim way to go. Your very marrow is in revolt, as the cancer takes over the blood-making processes.
Since it could happen to any of us, I hope you will concentrate for a second on the case of a constituent of mine, a distinguished and charming author. When I last met him, he was running the second-hand book stall at the fête, and seemed very cheerful. I did not know it, but he was already well down the track that begins with radiography and then goes on to chemotherapy and stem-cell transplants, and then to courses of melphalan and steroids.
Now he has come to the last drug in humanity's current pharmacopoeia. It is called Velcade, and it is a good drug, fully licensed in this country. His doctors have told him that it would improve the quality of his life, and perhaps prolong it by two to five years.
It is available free in the healthcare systems of virtually every other European country; and yet he cannot get it in Oxfordshire. It is not available to him, or anyone else, on the Oxfordshire NHS.
He says, rather mildly, that he feels this is "unjust". I think that is an understatement. It happens that Oxfordshire is one of those counties particularly penalised by Labour, in that our per capita healthcare funding is only about 85 per cent of the national average. It is true -- though obviously grossly unfair -- that there are some primary care trusts (PCTs) in England that do feel rich enough to be able to afford Velcade, and today it is still being given to many multiple myeloma sufferers in other English counties.
And yet, in just a few days' time, the position is about to become worse. The injustice will shortly become an outrage. On September 6, the National Institute for Clinical Excellence (Nice) is expected finally to rule, or "advise", that Velcade should not be dispensed on the NHS, with chaotic consequences for those English PCTs that are still giving it out.
And why is it being stopped? Because each course of treatment costs between £16,000 and £17,000. We must accept, in this country, that there are some treatments the state just cannot afford, and Nice will shortly rule that Velcade is not cost-effective.
Did I say "this country"? Forgive me. There will certainly be one part of Britain, if not England, where the NHS will continue to distribute Velcade, free, to sufferers from multiple myeloma. The drug will be available in Scotland, as it has been for some time; and, much as I love the Scots, it makes my blood boil that they should be so preferred.
Do you remember that deathless moment when a heroic Labour backbencher ambushed Tony Blair at Prime Minister's Questions, and asked him to describe his core political beliefs? The PM went white, and stammered, and, after a hilarious hiatus, he gargled, "Errr ... the NHS", and flopped back in his seat. And when Gordon Brown, his heir-presumptive, is struggling to sum up the "spirit of Britishness", the thing that really unites the country, he always goes for the "unique values of the NHS".
In a way, he is right. The NHS is an essential half of the symmetry of British politics. In property and economics, we may be more inegalitarian than some other European societies; but we compensate at the moments of birth, sickness and death with the total equality of the NHS ward.
So let me ask you this, Gordon: how can you call it a National Health Service? I mean, run that National bit past me again. Which nation are we talking about here? There are two nations, and England gets £1,085 per capita health spending and no Velcade, while Scotland gets £1,262 per capita and free Velcade for Scottish multiple myeloma sufferers, among many other benefits.
Gentlemen of England now abed, here is the position. The Scots have free nursing care for the elderly -- subsidised, under the Barnett formula, by us, the English -- while we cannot afford it in England. The Scots have the luxury of refusing to charge their students top-up fees -- since they are subsidised by us, the English -- while English students have to cough up. Now we learn that the Scots have free cancer drugs -- subsidised by us, the English -- while we in England are told they are not cost-effective.
And all this injustice is provoked by a fundamental constitutional imbalance. It was because of devolution that the Scottish equivalent of Nice was able to decide that it no longer needed to obey the rulings of this so-called "National" body. It is because of devolution that Scots are able to make their own health arrangements, in the comfortable knowledge that Whitehall will bung them an extra couple of hundred quid for every Scot. It is because of devolution that the numerous Scottish MPs, with their small constituencies, are able to vote on questions that affect England, while English MPs have no corresponding say over healthcare in Scotland.
It is just not good enough for Alistair Darling or John Reid or Charlie Falconer or Gordon Brown or any one of these smooth-talking Scots to say, as they do, that the only answer to the West Lothian question is to "stop asking it".
Gordon Brown had better understand that if he wants to become prime minister, he must find a solution to this, fast. Scottish devolution -- of which he was such an evangelist -- has smashed its Mel Gibson broadsword through the NHS.
How can you call it a National Health Service when we officially sanction a financial division, by which sufferers from a horrifying disease will die between two and five years earlier in England than in Scotland?
There's no more NHS. There's an EHS and an SHS. This is no longer some abstract constitutional issue. This is life and death. Unless Labour sorts it out, the shires of England will not be asking for devolution, but revolution, and they will be right.
As for Nice, it's absurd to pretend that there is anything National about it. It's time to drop the N and put Nice on ice.