A dangerous lie is stalking the NHS: that it is no longer fit for purpose
Each time I’ve gone for a Covid jab, I’ve walked out with a warm glow. It wasn’t just relief to have the protection, or awe at the scientific feats that were pulled off to get a vaccine in my arm, but a sense of national pride in the NHS, an institution that is collectively ours, there for us in good times and bad. Just seeing the NHS’s distinctive blue-andwhite logo is enough to make my heart swell a little.
I am far from alone. Britons feel more proud of the NHS than we do of the royal family or the armed forces. It’s been a constant source of frustration for the supposedly patriotic political right over the past 40 years, leading former chancellor Nigel Lawson to coin the cliche of the NHS as an English religion in the early 1990s. According to them, our soppy sentimentalism is holding the country back from getting the healthcare we need.
Times have changed: recent years have brought us the phenomenon of Tory health ministers proudly sporting that logo on pin badges on their lapels. But there remain a number of politicians and commentators who are cynically using the pandemic to argue that the NHS is structurally unsound and in need of major reform.
The argument goes like this. We are spending more on the NHS than ever. Too much is eaten up by bureaucracy. If we keep on at this rate, NHS demand will eventually crowd out spending on things like schools and the police. But despite all that record-breaking resource, we suffer inferior health outcomes than many of our European neighbours. The pandemic has made things worse, and the only way to fix this is to do the unthinkable: break up the NHS.
Its proponents present themselves as cool-headed rationalists battling the pathetically romantic predilections of a nation. But the reality is that their argument is as ideologically fuelled as arguments come, and it relies on some highly disingenuous sleights of hand.
First, on spending: their analyses draw on 2020 data to argue that the UK spends more on health than any other European country as a proportion of GDP. But the year of coronavirus is a terrible year to draw international comparisons: that spending includes all the extraordinary pandemic costs such as test and trace and protective equipment, while the GDP hit by the pandemic varied hugely across countries.
The UK had to spend more than countries which already had a much better public health infrastructure. We also got terrible value for money in some areas, thanks to dreadful contracting decisions that had nothing to do with the NHS; and I haven’t seen many argue we should have spent less on vaccines.
Long-term data show just how efficient the NHS is. We spend significantly less per person than comparable countries such as Germany, France, Switzerland and Sweden. We have far fewer hospital beds a head, way below Germany, France and Austria, and fewer doctors and nurses a head than the OECD average. Pro-marketisation proponents argue that too much goes on pencil-pushers. (Would they really want to be treated in a hospital populated with frontline clinicians, but no managers?) The 2012 NHS reforms that tried to introduce more competition and are now in the process of being reversed ended up creating more bureaucratic inefficiencies, not to mention a huge one-off price tag.
The second sleight of hand is to ignore why Britain has poorer health outcomes than some of our neighbours, for example on infant mortality and cancer survival rates. These outcomes are more a product of societal factors – levels of obesity, eco
nomic inequality and air pollution, for example – than a reliable guide to the quality of a country’s healthcare system. Quality of care obviously has an impact, but it is generally good, and often outstanding, in the NHS. That’s not to say there aren’t pockets of low standards of care – just look at the recent spate of hospital baby death scandals – but why would ripping up the system do more to address these than focusing on more granular issues such as cultures around safety, addressing gaping staff shortages, and quality of leadership?
“Almost every paper I’ve read says broadly the same thing: there’s no single form of healthcare system that’s demonstrably better or worse than another, and the costs of transitioning to another system are huge,” I’m told by Siva Anandaciva, chief analyst at independent health thinktank The King’s Fund.
The real story is this. Until 2010, the NHS had historically been given realterms funding increases of 4% a year on average: not a sign of inefficiency, but of the fact that countries spend more on healthcare as they get richer, cutting-edge health technologies become more expensive over time, and ageing societies have more people who need more healthcare. However, over the past decade, the NHS has received the tightest funding settlement in its history, way below this average.
Recently announced cash injections will help but do not fill the gap or fix a lasting legacy of old and dated equipment, pay and recruitment freezes that have left the NHS severely understaffed, and a lack of capacity that meant non-critical operations, such as hip surgery, were being suspended during winter crises well before the pandemic hit.
The real danger from the anti-NHS ideologues is not that they succeed in getting a big-bang break up of the NHS but that they help hawkish politicians such as Rishi Sunak to succeed in winning the crazy argument that we are spending too much on our health.
A myth of this pandemic is that there will be a moment when the NHS implodes: there one minute, not the next. Reality is far more insidious: the guarantee that the NHS is there for you when you need it might succumb to gradual erosion as waiting lists soar, repeat surgery is cancelled and ambulance waiting times grow dangerously long. As this continues, more of those who can afford to will opt out of the service, undermining the NHS creed of universality. That is the ultimate prize for some on the right who would like to see the NHS become a residual safety net rather than the institution to which we collectively turn in times of need.
The right’s argument on the NHS is ideologically fuelled and relies on some highly disingenuous sleight of hand