NHS treats us like paupers and expects us to be grateful

Why are so many proud of a Soviet-style system that embodies the ‘we know best’ mentality of the state?

Iwas going to write about Wednesday’s Budget, but really there seems little point. Welcome as the 2 per cent National Insurance cut and the change to child benefit rules are, overall the Budget does nothing to change our direction of travel towards a social democratic economy: high tax, high spend, big state, and hence low growth. It therefore also does nothing to improve Conservative electoral prospects.

It is not then surprising, amid this world-weary acquiescence in collectivism, this stealing of Labour policy clothes, that we should find Jeremy Hunt referring approvingly to the NHS, and finding another £5-6billion for it: small change, after all, in our health budget.

He claimed that the NHS is “the biggest reason most of us are proud to be British” and unfortunately, according to the polling, he is right. An Ipsos Mori survey last year showed that, incredibly, 54 per cent of us put the NHS at the top of the list of reasons to be proud of being British, way ahead of our history, at 32 per cent, or our democracy, at 25 per cent.

I say “incredibly” because most developed countries have a health system that is free at the point of use, too; most systems’ outcomes are better than ours; and satisfaction with ours is at historic lows. So the baffling centrality to British national identity of the NHS as an institution remains to be explained.

It is easy to see why socialists like it. There is the Attlee and Nye Bevan mythology. There is the erasure from political history of all the (rather successful) pre-1948 arrangements for providing health care. There is the rhetorical emphasis on fairness and on equality – with queues and handouts as their necessary consequences, not phenomena that ever bother socialists very much.

Behind it all, for the Labour Party, is a belief that, in an ideal world, the whole economy would be like the NHS, with market forces excluded and services allocated not bought. This is why Leftists like Jeremy Corbyn are obsessional about excluding any market transactions within the system: all cleaning, all car parking, all clothing provision must be done by the government for fear of contaminating the NHS’S moral purity.

It is less obvious why so many Conservative politicians are believers in the NHS, or at least pretend to be. For one thing, you might hope they would reflect their voters. In that Mori poll, 71 per cent of 2019 Labour voters put the NHS at the top of their list, but only 31 per cent of Conservatives. It is also noticeable from that poll that older voters, who might be thought to have most experience of the health system, are significantly less proud of it.

But it is a rare Conservative politician who will express any doubts about the health service and Jeremy Hunt certainly is not one of them. He has written a whole book about the NHS and his efforts to reduce avoidable harm and death within it – an astonishing 150 avoidable deaths every week.

As he rightly says, solutions to this problem do exist – better accountability, better prevention, better technology. But he shows a touching belief in the ability of ministers and managers to make them happen, despite all the evidence that the problems just repeat and repeat.

In truth, improvements are made despite the NHS system, not because of it. That’s not surprising in this Soviet-style set-up which has no competition, no real incentives, and no consumer power. If airlines kill their passengers, people stop flying on them, and their staff stop working for them. But if your local maternity centre kills too many babies, as all too many of them seem to keep on doing, you are stuck with it.

Hunt proudly says that the NHS’S strength is that in it “we are always patients and never customers”. That, unfortunately, is precisely the issue. It would be more accurate to say that we are always patients and always paupers. When you walk across the threshold of an NHS institution, you become a pauper, at the mercy of those who run it, just as much as someone entering a Victorian workhouse.

You must take the service you are given as and when the staff are ready to provide it. If you get good and kind treatment, as of course many do, you are lucky – which is why so many think it worthy of public comment. But you might not be lucky. If you need to change an appointment, but can’t contact the hospital: too bad. If you suffer while a GP receptionist decides whether you are a worthy “case”: too bad. And if you die on a waiting list: too bad.

That mindset of we know best and you must put up with it is the true spirit of too many of those who govern Britain today – sadly, in all parties. Take what you are given and like it, and if things go wrong you’ll be taxed to pay for the mistakes. We see it in net zero, in immigration policy, in planning law, the Post Office scandal, and more.

The NHS isn’t an anomaly within this system: it’s the apotheosis of it. That’s why it must change.