We can’t save the NHS until we acknowledge its failing health
The NHS has had to cancel 50,000 non-urgent operations to deal with the winter crisis. This is not normal.
The Prime Minister may be pretending everything is fine, but this is not acceptable.
The trouble is that, beyond the acknowledgement that there is a very serious problem with a health service that spasms in predictably cold seasonal conditions, the national conversation grinds to a halt.
The NHS is sacred. Criticising it in any way, even in an attempt to improve it, is therefore sacrilege.
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And hence we have the absurd situation where health secretary Jeremy Hunt, who is not even responsible for how much money the NHS receives, is dragged before the cameras to personally apologise to individuals whose operations have been cancelled.
So let’s go back to basics. What does the NHS do well, where is it failing, and how can we fix it?
There is no denying that universal healthcare is an admirable achievement, if not a unique one. Britain was a pioneer, and we should rightly be immensely proud.
One need only look to the US, where, before the Affordable Care Act, children were dying of tooth infections and a cancer diagnosis often went hand in hand with bankruptcy, to see the importance of healthcare free at the point of use.
Unfortunately for our egos, the US is not the only point of comparison. And while we feel smug that the British system will never force an individual to choose between a CT scan and a month’s rent, we are doing ourselves a disservice if we pretend that’s good enough.
In the vast majority of international rankings of healthcare systems, most of which are social insurance schemes rather than single-payer, the NHS routinely comes in the bottom third for health outcomes.
While it is true that the UK spends less on healthcare than some countries which have better outcomes (France, Germany, Switzerland), it spends the same or more than others, where outcomes are far superior (Iceland, Australia, New Zealand, Israel).
The one study that places the UK top of the charts for access was by the Commonwealth Fund, and was written up by the Guardian accompanied by the following quote: “the only serious black mark against the NHS was its poor record on keeping people alive”.
Clearly, we can do better, even in normal times. And as for the winter crisis, other nations face extreme weather (and an averagely cold January is not that extreme), without cancelling tens of thousands of hip replacements and hernia operations.
None of this in any way detracts from the incredible work of frontline NHS staff, who are, we are told, working in “third world conditions”. The picture painted is of devoted but exhausted emergency room staff pulling dangerously long back-to-back shifts, to see patients who pile up in the corridors because no beds are available.
No one is underestimating the dedication and endurance of healthcare workers operating under such extreme pressure. The system would be collapsing without their professionalism. But that is not a sustainable foundation for a healthcare service in the sixth largest economy in the world.
At this point, the answer from the Labour party is to demand more money. It is true that, while the healthcare budget has been rising at around one per cent a year, aging demographics and population growth mean that demand has been rising more steeply.
Maybe the NHS does need extra funding to cope. But Britain already spends more on health than the OECD average, so at some point we need to question whether that money is being used in the most effective way.
At the moment, we cannot even have a sensible conversation about car parking charges at hospitals without it turning into a political mudslinging match. Jeremy Corbyn’s attitude of fund everything, always, may sound popular, but it is unsustainable. If the NHS is indeed in crisis – which has been Labour’s catchphrase every winter for decades – then we need to fix it.
Politically, this is the ultimate hot potato, so let’s try to take the politics out of it.
Theresa May should launch a commission of doctors, academics, business leaders and politicians from all parties. Set them the task of rethinking what we want our health service to be, how much we’re prepared to spend, and what is the most effective way of achieving this.
We need Labour to stop pretending the answer is always more money, and the Tories to stop ignoring the problem or blaming the individuals who use or work in healthcare.
This isn’t about dismantling the NHS, starving it of cash, or privatising it and hawking it to the highest bidder at the expense of patients. It’s about being realistic regarding its capabilities and limitations.
This year is the health service’s seventieth anniversary. It is bizarre to think that a system designed when life expectancy was 12 years lower than it is today, with radically different cultural and technological approachs to medicine, is still the best possible model in 2018.
If we’re ever going to solve this problem, we need to admit the basic truths. Some 50,000 patients are paying the price of our failure to do so this winter. Let’s not make it another 50,000 next year.
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