making TV programmes to make policy to go on TV with

Here is a horrible piece of work. Tory MP Charlotte Leslie in the Grauniad says stuff.

But Norman Warner is “brave” in a good way, though I disagree with him. Lord Warner, the former Labour health minister, has suggested that if we are to preserve our NHS, we should charge a £10 “membership fee” to help pay for it.

Despite suggesting an answer I cannot agree with, he is responding to the right question – a question so taboo that almost no other politician has had the courage to tackle it. There are other answers apart from his – I for one am loth to jettison the NHS being “free at the point of use” – and we must debate them.

First up, anyone who says no other politician has had the courage to discuss something is usually lying.

Second, Warner is full of shit. Who’s to pay this tenner? How much money would that be? Citizens? Workers? In the UK, or England, or what? If it’s the UK workforce, about 44 million people, that would be about 0.34% of the total UK-wide spend. That’s not going to save anything. Maybe he has some sort of squashy notion of “ownership” or some such, but it’s hard to think of anything the political nation is as attached to as the NHS. Further, we already pay an NHS membership fee: it’s called National Insurance, and you know, Gordon Brown tried putting that up to help the NHS and it worked! It’s even broken out on your pay slip so you can see it.

Roll the tape on.

The question we are all frantically evading is how on Earth we continue to fund an NHS that was devised for a much smaller population, with vastly different expectations, at a time of far more limited and less expensive medical possibilities, and when we died much younger.

A much smaller population? It wasn’t just devised for a much smaller population, it was devised for a much smaller economy, too. Between 1951 and 2008, i.e. pretty close to the first 60 years of the NHS and because I’m being quick, the UK added 9 million people, about 20%. In roughly the same period of time, the UK gross domestic product at 2000 prices more than quadrupled. The population is 20% bigger, but four times as rich. Here’s a chart, per capita, allowing for inflation. What is this drivel?

As always with this sort of stuff, the problem seems ridiculously puny. Apparently too many people go to A&E, when they really ought to see their GP.

Dispatches exposes the unsustainable number of us who go to A&E who simply don’t need to, hindering the genuinely needy from accessing care. There are many reasons – inadequate information and triaging systems, the fact people see A&E as the “safe” option, and that getting a GP appointment can be so tortuous.

And some people miss appointments with their GPs. The monsters.

Patients miss 12m GP appointments every year, at a cost of £160m. An NHS free at the point of use is one thing but can we afford it to be free at the point of “no use”? Could we charge for misuse of the NHS – perhaps £10 for a missed GP appointment?

That would be 0.13% of the UK-wide spend. Perhaps the 12m numberoid is England-only, in which case it’s a whole 0.15%.

But apparently too many people are going to see their GPs, too.

There is a second problem: GP clinics are also clogged up with people who do not need to be there.

The problem is that everyone’s gone soft, and needs a dose of Donner Party conservatism, it seems.

Most of us have never been near the ubiquitous grief and suffering that our war-ravaged grandparents endured. Instead we have been told that we “deserve” things (we are seldom told exactly what we have done to deserve them), so as a generation we generally expect them, and now. Our lifestyle has broadly made us less stoical, less self-sufficient and more demanding than “Generation NHS” – our grandparents.

Really? The people who pretty much by definition were the most committed to the NHS, and who also by definition used the most of its resources?

Anyway, what we need is a good solid nudge to get us back on track.

Perhaps we should be issued with receipts for the cost of our GP or A&E appointment? This will not fill the funding gap, but it may trigger a behavioural change and remind us that the NHS is far from free.

If people were handed scary bills, maybe they might not go to the doctor, or to A&E. This would have done the following patient so much good:

A GP colleague who still practises often tells of how an octogenarian came into his surgery, dressed up for his appointment, with crushing chest pain and began, “I am so sorry to take up your time, doctor”. He was rushed to hospital. The very next patient was a girl in her early 20s, still in pyjamas, who announced she had a sore throat and what was the doctor going to do about it?

You bet. This par may sound over perfect, but there’s a good reason for this. Charlotte Leslie is responding to a TV programme.

Channel 4’s Dispatches tonight tackles one uncomfortable aspect of this challenge head-on.

TV programmes, whether fictional or factual, are films. Films are edited to create a dramatic narrative. Cutting patient 1 into patient 2 makes story. Story is watched. And she ought to know, because it is her own TV show she is spruiking!

So in Dispatches, I put my money where my mouth is and ask some of the questions that doctors are asking but which politicians concerned about elections studiously ignore.

Charlotte Leslie is the Conservative MP for Bristol North West, therefore, a politician. Spare us the shtick with the white coat, already. We could go on; she wants to bill anyone who turns up drunk at A&E, unless they have a drinking problem or are actually ill. That doesn’t sound very workable, and anyway, surely those people can’t cost much because they don’t use any actual treatment, and she even says 50% of A&E patients don’t actually need any treatment.

More importantly, what the fuck is Dispatches, which I can remember doing journalism, up to here? Leslie is an active politician in the run-in to a general election. As such, her party gets its whack of election broadcasts. Nothing more. But here we have a massive, prime-time, hour-long slab of Tory access. And it’s not an isolated incident.

Channel 4 invented “Benefits Street”, and then Iain Duncan Smith cited it as evidence to a parliamentary committee as if it was the real world. Faisal Islam sucks up to Wonga and Create Streets. Now, having created “White” Dee as a sort of poverty starlet, Channel 4 has managed to get her a slot at the Conservative Party conference.

I confidently predict that like everyone who’s done the Tories’ utterly cynical bit of urban slot (see here), she will end up telling the Guardian Society supplement how they let her down in 18 months’ time. Even the Lib Dems do it these days and Jesus Christ, just look at how.

But there is something genuinely new here. We’ve had pols taking their cue from TV. We’ve had pols trying to bully the TV. We’ve had pols apparently convinced that TV is real. Now, for the first time, we have a pol who made their own TV show, who is also convinced that it is real. Channel 4 is hopelessly lost since some time in the second quarter of 2000, but at least it is worth complaining that the Guardian is part of the PR beatup.

Q2 2000, you ask? Yup. Work requires that I know the OFCOM Communications Market Report backwards and forwards.

People who watch more TV than I do tell me something interesting happened on C4 then.