The NHS: The envy of nobody

25 May 2017

The prevailing attitude in the UK is that it is socially unacceptable to be anything other than a fervent admirer of our healthcare system which, we are frequently told, is ‘the envy of the world’. This begs the question why, if the other 195 countries in the world are green with jealousy at the excellence of our system, they haven’t copied it in the sixty-eight years since its birth.


The reverence for nationalised healthcare stems from two main causes: firstly, it employs a staggering 1.7 million people, making it the fifth biggest employer in the world. The result of this is that, given one fifth of people working in our country work for the NHS, most know someone who is a part of the monolith, and are consequently biased in favour of it.


Secondly, people suspect that the only alternative to the NHS is a fully privatised system; the most common response to any suggestion to change the NHS is to bleat 'we don’t want to become like the US' and cite an example of an American friend who had to take out a second mortgage in order to have their tonsils removed. As we will see later, this needn’t be the alternative.


That said, this writer’s personal bias against the NHS is equally anecdotal, although it’s an experience that probably won’t be alien to many readers. One family member, suffering from a condition called frontotemporal dementia (FTD), had to wait nineteen months before being incorrectly diagnosed with Alzheimer’s disease, and was presented with this information with all the sensitivity and bed-side manner of a sociopathic wasp. This same lady, whose condition has now rendered her only capable of consuming a liquid diet, was presented with mince pies and bananas during a recent stint in hospital, and had fortified food supplements withheld because they were “too expensive”, even though she was eating no other food.


Another, healthy, family member was unable to obtain information about his mother’s cancer because while the consultants did their rounds in the morning, family visiting hours were deliberately only scheduled for the afternoon. Another relative, 24 hours from death, spent 4 of those hours on a trolley in a corridor in A&E, because the disjuncture between GPs and hospitals meant the correct department for his condition couldn’t be contacted.


However, evidence of the NHS’s shortcomings exists beyond personal experience. Sir Bruce Keogh found that 1,200 patients died needlessly at Stafford hospital between 2005 and 2008. The Euro Health Consumer Index found that the UK came 14th in Europe 'mainly due to poor accessibility (together with Poland and Sweden the worst among European healthcare systems) and an autocratic top-down management culture'.


The UK has a poor record on treating cancer - OECD data shows that, out of 23 developed countries, the UK ranks 20th in bowel cancer 5-year survival rates. Finally, this same OECD study, in a complex model that looks at outcomes (infant mortality, life expectancy, and mortality amenable to healthcare) said the UK came 24th out of 30 in efficiency rankings of high-income states.


Presented with this information it would require either someone incapable of rational thought, or someone who was ideologically attached to the concept, to conclude that changes aren’t necessary in the NHS – the service provided is not that of a developed country.


The French universal healthcare system (where they pay for health through national insurance-style ringfenced contributions) is both better-funded and puts patient choice, provider competition and mutualism front and centre. This creates accountability and drives up standards. The French are used to a patient-centred system, where they are a member of one of several public insurance funds and have their pick of doctors and hospitals. A French Socialist health minister once described the lack of choice in the British NHS as 'medieval' by comparison.


The notion that a public monopoly directed by Whitehall bureaucrats (who need not have medical expertise) is the only way of running a health system is wrong. Just because you want the state to guarantee access to a service doesn’t mean the state has to be the actual provider. The state can ensure free-at-the-point-of-use access without being the service provider.


Labour have used a variation of 'The Tories want to privatise the NHS' in every single election campaign since the NHS’ birth. The irony of this is that even Attlee in the years prior to his downfall set about the de-nationalisation of certain aspects of the system, including dentistry and GPs, as he saw the system as being simply too inefficient.


An Ipsos Mori study in 2013 found that the NHS is the main source of British national pride, beating the army into second place - as a nation we are prouder of a healthcare system that ranks 14th in Europe than of servicemen and women who fight and die for liberties and freedoms across the globe. This summarises the issue – pride in the NHS is so entrenched that criticism of it can be dismissed as immoral and fascistic without proper and logical analysis. The truth, though, is that even one of the NHS' founders saw its weaknesses.




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