My personal NHS experiences haven’t been so bad. Thankfully, either through conscious effort or sheer genetic luck, I haven’t had any serious medical concerns over the years, with a little bit of physiotherapy and a brief period of mental health treatment the only real blotches on my medical history. Each time I’ve had to use a clinic, GP surgery or hospital, procedure has been reasonably smooth and staff helpful and reassuring.
For the most part, those who work in our health service do a tremendous job. They work long hours, often far beyond what they are contracted to, and really do make a difference in people’s lives. I sometimes think that, given the NHS’ blatant inefficiencies, it is the efforts of staff alone that help to maintain strong public opinion of the organisation. Even when visiting my local surgery I get a pretty clear picture of the sheer magnitude of demand placed on the health service. I daren’t imagine what hospital winters are like.
Notice first and foremost that I make a distinction between the NHS and its staff. This is done so deliberately, not because I love one and hate the other, but because it makes debating the future of the service a little easier. We have, in the UK, a very real connection to a treasured institution, so any critique can often be dismissed as personal attack or Right-wing irrationality. Getting over this sacred cow treatment and attitude towards healthcare would be the national equivalent of an alcoholic admitting that he is so.
Dr Kristian Niemetz noted in a lengthy overview of the health service for the IEA on December 4th, 2015: “The NHS’ status as a sacrosanct institution promotes ‘groupthink’ and undermines the ability to detect and correct instances of failure, and adapt to changing circumstances.” He is undoubtedly correct. The first step towards injecting the UK’s NHS debate comes from admitting that even something we love so dearly has its problems, and that the sacred cow treatment it receives is damaging and unjustified.
An intriguing report published by the BBC on the problems facing the National Health Service can be read in full here:
It is unsurprising to me that our society has such an ingrained attachment towards the main entity in the healthcare sector. Most people alive in Britain today were born on the NHS, have been treated by the NHS and will die on the NHS. But what is bewildering is why, given this affection, we let politicians to this day use it as a political football. Healthcare, after all, is on its own terms a private affair. The NHS was set up in a silent, broken country still reeling from the effects of the Second World War. The idea (however inherently flawed) was that people would have access to care based not on ability to pay, but on clinical need.
So herein lays the second step towards providing the NHS debate with some much needed clarity: we must recognise that the society in which our health service was so proudly set up no longer exists. The country is very different now from the post-war era. Free movement of people has increased overall demand as well as introduced new, complex problems to an already over-burdened service. Health tourism, frequently earmarked by doctors as a major structural and financial problem, is one such issue. It is good that we look after those who need help, regardless of where they are from, but compassion can all too easily fall victim to corruption and exploitation.
The NHS is a public service, and thus is set up for public use. If public dynamics change, such as increases in how long we are living or how rapidly the population is growing, then pubic services must adapt in order to reflect those changes. A stale setup will not suffice in an age where British citizens are used as a cash cow (even those on low incomes pay hundreds in National Insurance) for a service that many now feel does not meet their needs. Public satisfaction is noticeably declining.
A third change in social attitude that must prelude any reasonable proposals to address healthcare in Britain relates to the United States. In the UK, too often we conflate private, market-based healthcare with the widely-condemned American system. This, for two reasons, is an unhelpful conflation that only manages to worsen unwarranted support for maintaining nationalised healthcare.
Firstly, the notion that American healthcare is private is largely a flawed one. The World Bank notes that state spending on healthcare by 2014 had reached just over 17% as a proportion of GDP. Back in July, the U.S government announced that they expected total state healthcare expenditure to rise to $10,365 per head. There is clearly something to be said for the claim that the private sector is at fault for very real faults in American healthcare.
Secondly, using the United States as a projection for market and insurance-based models in the UK ignores the very tangible successes with similar systems in Europe. A BowGroup (respected Conservative think tank and research body) report summarised starkly:
“UK Healthcare continues to be much worse than in Europe. 323 lives are lost per day because we are not matching the best European standards in the three main killers – heart disease, respiratory disease and cancer. That’s 117,743 per year. 85 lives per day (or 30,965 per year) are being lost because we are not even matching EU average standards. Looking at trends over time, there has been no significant improvement over the last 7 years. Another good measure of the quality of healthcare is the survival rate once a disease has been diagnosed. On this measure, the UK is bottom of the league table of Western European countries for cancer survival rates. In fact, you have more chance of surviving lung cancer in Poland, Estonia or Slovakia than you do in the UK. In France, patients are twice as likely to survive lung cancer as they are in the UK. Significantly more money has recently been put into the NHS in the last seven years. But standards are still much lower than in Europe and activity (e.g. number of operations) has not increased. Money alone has not worked.”
It is possibly due to the bureaucratic, centrally organised nature of the NHS that funding is not necessarily put to good use. Left-wing commentators and publications will, from time to time, refer to budgetary cuts as the source of these problems, but as studies frequently show, Britain’s successes in dealing with severe illnesses – of which cancer has emerged as a particular problem – have stagnated, likely due to the inevitability of longer waiting times in state-monopolised healthcare systems and irrespective of funding levels.
Europe has quietly managed to avoid the problems that we face by seeing and treating healthcare for what it actually is: a private concern, better organised efficiently than in a way that is necessarily universally liked. So the NHS zealots, which are also found on the Right in surprising numbers, would do well to concentrate on provision on the continent, and stop using America’s woes as a barometer for eternal market failure.
So, ditch the sacred cow treatment, acknowledge the many social changes that have taken place between now and the 1940s, and consider European templates before screeching about U.S healthcare. Only then, if we are to have a rational discussion, can we talk about what to do with the NHS.