Last autumn, a survey tried to identify the 50 things that make Brits feel most proud to be British. The list contains a lot of entries that fully deserve to be there: “proper pubs”, “roast beef”, “the Lake District”, “James Bond”, “Harry Potter”, “real ale”, “the Salvation Army”, “Worcestershire Sauce”, “Hadrian’s Wall” – all excellent stuff.
But it also contains two embarrassing entries that really should not be there: “beans on toast” and “the NHS”. Come to think of it, the former is actually fine, given that it is almost certainly meant ironically. But the NHS tops the list by a wide margin, and I’m afraid people mean it.
The NHS. Seriously? Would that be the same NHS that is currently under investigation again, on the Health Secretary’s order, after an unusually high number of avoidable infant deaths at one of its trusts? The same NHS where standards of maternity care are, according to the Care Quality Commission’s Chief Inspector of Hospitals, often “truly shocking”? The same NHS that gave us Mid Staffordshire?
We are normally proud of things that are, in some way, exceptional. That’s why real ale is on the list, while Carling is not. Genuine question: what’s exceptional about the NHS?
The fact that it’s universal, that it provides care to everybody irrespective of ability to pay? Standard fare. All healthcare systems in the developed world do that, with the US system being the only major exception.
The fact that it is generally free at the point of use, with very little out-of-pocket spending? Nothing special either. Plenty of systems are, or where they have modest co-payments, they exempt people on low incomes and/or with high health needs.
The fact that it offers modern technology and modern medicines? Meh. All healthcare systems in the developed world do that, and plenty of them are more innovation-friendly than the NHS.
The fact that it runs on compassion and solidarity, rather than self-interest? Give me a break. Of course it runs on self-interest. Let’s do an experiment: let’s cut doctors’ pay by a quarter or so and see how many of them would still turn up to work.
Now, if it delivered impressive outcomes, that would indeed be a reason to be proud of it. The Swiss have good reasons to be proud of their healthcare system. They have the lowest rate of (healthcare-related) avoidable deaths in Europe, possibly in the world.
The Dutch have good reasons to be proud of their system too. It is an exceptionally generous system which offers fast access to a broad range of treatments.
The Japanese and the Israelis have good reasons to be proud of their systems. They achieve phenomenally good survival rates for cancer and stroke.
And then there are the French, German and Belgian systems: not spectacularly good in any one particularly category, but consistently good across the board.
The NHS? Nearly always in the bottom third of the league tables, usually about on a par with the Czech Republic and Slovenia.
Everyone the Government blames for the NHS crisis – except themselves
Everyone the Government blames for the NHS crisis – except themselves
1/6 The elderly
“We acknowledge that there are pressures on the health service, there are always extra pressures on the NHS in the winter, but we have the added pressures of the ageing population and the growing complex needs of the population,” Theresa May has said. Waits of over 12 hours in A&E among elderly people have more than doubled in two years, according to figures from NHS Digital.
2/6 Patients going to A&E instead of seeing their GPs
Jeremy Hunt has called for a “honest discussion with the public about the purpose of A&E departments”, saying that around a third of A&E patients were in hospital unnecessarily. Mr Hunt told Radio 4’s Today programme the NHS now had more doctors, nurses and funding than ever, but explained what he called “very serious problems at some hospitals” by suggesting pressures were increasing in part because people are going to A&Es when they should not. He urged patients to visit their GP for non-emergency illnesses, outlined plans to release time for family doctors to support urgent care work, and said the NHS will soon be able to deliver seven-day access to a GP from 8am to 8pm. But doctors struggling amid a GP recruitment crisis said Mr Hunt’s plans were unrealistic and demanded the Government commit to investing in all areas of the overstretched health service.
3/6 Simon Stevens, head of NHS England
Reports that “key members” of Ms May’s team used internal meetings to accuse Simon Stevens, head of NHS England, of being unenthusiastic and unresponsive have been rejected by Downing Street. Mr Stevens had allegedly rejected claims made by Ms May that the NHS had been given more funding than required.
4/6 Previous health policy, not funding
In an interview with Sky News’s Sophy Ridge, Ms May acknowledged the NHS faced pressures but said it was a problem that had been “ducked by government over the years”. She refuted the claim that hospitals were tackling a “humanitarian crisis” and said health funding was at record levels. “We asked the NHS a while back to set out what it needed over the next five years in terms of its plan for the future and the funding that it would need,” said the Prime Minister. “They did that, we gave them that funding, in fact we gave them more funding than they required… Funding is now at record levels for the NHS, more money has been going in.” But doctors accused Ms May of being “in denial” about how the lack of additional funding provided for health and social care were behind a spiralling crisis in NHS hospitals.
5/6 Target to treat all A&E patients within four hours
Mr Hunt was accused of watering down the flagship target to treat all A&E patients within four hours. The Health Secretary told MPs the promise – introduced by Tony Blair’s government in 2000 – should only be for “those who actually need it”. Amid jeers in the Commons, Mr Hunt said only four other countries pledged to treat all patients within a similar timeframe and all had “less stringent” rules. But Ms May has now said the Government will stand by the four-hour target for A&E, which says 95 per cent of patients must be dealt with within that time frame.
6/6 No one
Mr Hunt was accused of “hiding” from the public eye following news of the Red Cross’s comments and didn’t make an official statement for two days. He was also filmed refusing to answer questions from journalists who pursued him down the street yesterday to ask whether he planned to scrap the four-hour A&E waiting time target. Sky News reporter Beth Rigby pressed the Health Secretary on his position on the matter, saying “the public will want to know, Mr Hunt”. “Sorry Beth, I’ve answered questions about this already,” replied Mr Hunt. “But you didn’t answer questions on this. You said it was over-interpreted in the House of Commons and you didn’t want to water it down. Is that what you’re saying?” said Ms Rigby. “It’s very difficult, because how are we going to explain to the public what your intention is, when you change your position and then won’t answer the question, Mr Hunt”. But the Health Secretary maintained his silence until he reached his car and got in.
But what about the Commonwealth Fund study, which rates the NHS as the best healthcare system in the world? The Commonwealth Fund study is the outlier among health system rankings, because it pays little attention to outcomes – it is mainly based on survey responses and general system characteristics. But it has one category which does relate to outcomes, and in that category, the UK comes out 10th out of 11 countries. So even the preferred study of NHS cheerleaders confirms that in terms of outcomes, the NHS is one of the worst systems in the developed world.
“But it’s just because of underfunding!” I can hear you protest. Not so. Yes, some countries spend more money on healthcare than the UK. More money makes a system more generous. But it does not automatically make it better at dealing with its core functions.
In fact, in efficiency rankings, the NHS also comes out in the bottom third, just as it does on outcomes. Yes, maybe we should spend more money on healthcare. It cannot do harm. But it would not, on its own, sort out the system’s main problems.
The jingoism of Little Englanders is sometimes unedifying, but it is not nearly as cringeworthy as the NHS patriotism of the left. The NHS is the country’s most overrated institution. It is the Carling of healthcare systems. It achieves nothing that dozens of other healthcare systems do not also achieve, and usually better – and it’s time we admitted that to ourselves.Reuse content