Leading article: NHS crisis? What crisis?

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AN EPIDEMIC of flu and a shortage of hospital beds has brought the National Health Service to the brink of collapse. Or has it? Let us for once get things in proportion: for without a sense of proportion, information is a higher form of ignorance. Our hospitals, while rarely aesthetically pleasing, still treat vast numbers of people with perfect adequacy, and will continue to do so for the foreseeable future. Every day, untold numbers of patients receive life-saving or health-preserving treatment just as usual. Hospitals, in fact, do not collapse like houses of cards, as the more lurid of recent newspaper headlines suggest they might.

You can fall seriously ill or be seriously injured in any part of this country and be reasonably assured of competent medical or surgical attention within a short time. This has not been the case for most of mankind throughout most of history in most of the world. The slightest understanding of the medical suffering of our forefathers should be sufficient to convince us that, by the standards of all previous generations, we are astonishingly fortunate in our medical care, even in times of flu. Our problems are trifling compared to those of our forefathers.

Of course, we are inclined to compare what actually exists not with what existed in the past, but with what might exist in an ideal world. Thus we compare the NHS with a hypothetical health service in which no bed shortages ever arose, in which there were as many nurses as were needed, and in which no doctor ever made a diagnostic or therapeutic error. And judged by such a standard, the NHS is, indeed, defective. But then so is every other health system in the world, all of which have faults of their own.

It is curious and far from edifying to see the Tory party reacting to the present difficulties in the NHS precisely as the Labour Party might have reacted if it were still in opposition. In their many years of government, the Tories proved quite unable to solve the problems of the NHS, and so it is unreasonable of them now to expect a new regime to do so in less than two years. Their own introduction of the internal market into the NHS managed simultaneously (and with considerable ingenuity) to combine the profligacy of the marketplace with the inefficiency of a centralised bureaucracy, in the process considerably reducing the morale of the medical and nursing professions. It ill becomes the Tory party, therefore, now to pose as keepers of the sacred NHS flame.

In fact, no government will ever solve the problems of health care provision once and for all: when one problem is solved, another will simply arise to take its place. As the Haitian folk saying puts it, behind the mountains are more mountains. There is no country in the world that has successfully solved the conundrum of how to provide optimal medical care for all its citizens within a budget that it can comfortably afford. On the other hand, the health care systems of all developed countries (including our own) perform the vast majority of the tasks any health system is required to perform. The result is that the health statistics of all the countries of the OECD are remarkably alike. The infant mortality rates or life expectancies of these countries are within a few points of each other.

It is customary in times of obvious privation in the NHS to call for greater expenditure. This is because we in Britain spend less of our money on health care than any comparable country, and the assumption is that all our problems can be solved by an increase in expenditure. This is a myth. The Americans, for example, spend three times as much per capita on health care as we do, but figures suggest their health is no better than ours. The Germans spend twice as much, but their figures are slightly worse than ours. The health of the Danes, whose welfare state is so exemplary, is also slightly worse than ours.

What is presented to the public as an unprecedented crisis in the health service is in fact little more than one of the inevitable small oscillations in the provision of health care to a population of 60 millions. That people are so easily panicked into believing that collapse is at hand is the consequence of a lack of true perspective, either historical or geographical.

A state of constant anxiety is no more commendable than one of immovable complacency. The NHS is neither an immaculate institution incapable of improvement nor so terrible an abomination that it is beyond redemption. And if it is a virtue in a health care system that it should achieve its end economically, by means of comparatively small expenditure, then the NHS is still, despite its many faults, a virtuous system. Stories of medical incompetence, wickedness and folly notwithstanding, the majority of us have little reason to fear that we shall not be looked after properly when we are sick: and that, in the context of human history, is no mean achievement.

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