OUR WONDERFUL NHS: NOW IT’S TERMINAL
Despite repeated reform and huge investment, it is letting us down
Appalled that her 97-year-old mother couldn’t see a GP, BEL MOONEY wrote of her anger – and inspired our campaign for face-to-face appointments. Now she powerfully argues that the problem is so much deeper ... and that we MUST find the courage to rethink our entire ‘national religion’
FRUSTRATED by a GP’s receptionist blocking a face-to-face appointment for my 97-year-old mother, in June this year, I wrote a special report for this newspaper, criticising the very situation that has been the subject of the Mail’s recent, successful campaign.
It so happens that the medical attention my mother has received recently has been impeccable, and I do appreciate the pressures doctors face — with rising patient numbers due to an increasingly elderly and growing population.
Writing about the NHS must involve an understanding of complexity. You can express gratitude for good care from a family doctor or hospital consultant, but at the same time recognise that the system cannot be above criticism.
The article in question — just like this paper’s trailblazing campaign — drew a huge response from people who were equally frustrated and disappointed.
‘What’s going wrong with the NHS?’ was a common refrain. People who probably stood outside their houses during lockdowns — clapping and banging saucepans, with rainbows in their windows to thank healthcare workers battling Covid — could still express acute criticism of a vast, unwieldy institution they uneasily suspect is not fit for purpose.
Appalled by long waiting lists, cancelled operations, relatives’ cancer treatment put on hold until too late, furious (as I was) that a loved one’s cause of death was routinely certified as ‘Covid’ when untrue, and faceto-face appointments with GPs were as rare as hen’s teeth, exasperated and angry citizens wrote to me and to this paper asking: ‘Why?’
Such people — the silent majority — will be relieved that due to our campaign, Health Secretary Sajid Javid has called out GPs, launched initiatives and allocated funding to improve access.
NATURALLY, this prompted a howl of protest from the usual suspects — most notably the British Medical Association (the doctors’ union in effect). Former health secretary Jeremy Hunt predicted the measures aimed at increasing face-to-face appointments would spark an exodus from the profession.
‘This is a burnt-out workforce running on empty because of a massive mismatch between supply and demand,’ he tweeted. ‘The only thing that will convince them not to continue retiring or opting for part-time hours in droves is a clear plan to end the unsustainable pressure they face.’
Royal College of General Practitioners’ chairman, Professor Martin Marshall, said the criticism of GPs by politicians and the media over in-person appointments was ‘demoralising and indefensible’. The proposed support package was ‘not the answer’.
And so the battle — and the disconnect between patients and the institutions representing GPs — looks set to rage on, even as our beleaguered health service is about to undergo another of its frequent ‘reorganisations’, introducing a blizzard of new acronyms.
From spring 2022, for example, the current CCGs (Clinical Commissioning Groups) and their staff will become ICSs (Integrated Care Systems). As ever, the aim is to improve efficiency. As ever, the chances are slim.
Let’s cast our minds back to the early days of the NHS. Ironically, doctors were among the most vociferous objectors when it was first proposed.
Aneurin Bevan, the Labour politician who led the establishment of the NHS in 1948, was asked how he convinced them to take part, and he allegedly replied: ‘I stuffed their mouths with gold.’
Bevan recognised that to win over doctors to the world’s largest socialist experiment in healthcare, he had to appeal not so much to their morals, as to their pockets.
In the following decades, the system he created, with services free at the point of delivery, became not just the best-loved state-run body in the country but a key part of our national identity.
A good example of its totemic status came during the Olympics opening ceremony at London 2012, when nurses danced around hospital beds as a tribute to the NHS.
Against this backdrop, as many have found, if you write anything faintly critical of the NHS on social media the zealots pile in, like fundamentalists permanently on their knees to an out-dated dogma.
A few years ago, waiting with my late father for his eye appointment, I took a picture of a sign detailing the number of missed appointments that month — and what this selfishness had cost the hospital.
On Facebook, I suggested we should question whether people truly value what is free. Was it time to look again at the ‘free at the point of use’ principle? You’d have thought I had uttered the vilest blasphemy. All the nonsense about the ‘secret privatisation’ of ‘our NHS’ planned by wicked Tories was trotted out.
Similarly, when some years ago I wrote about the shocking ‘health tourism’ figures, middleclass bien-pensants with health insurance (for whom ‘waiting list’ is a foreign phrase) told me that of course the NHS should be free at the point of use, for everybody and anybody, for ever and ever, Amen.
A highly respected novelist I knew rebuked me loftily: ‘Criticism of the NHS is both ungrateful and unhelpful.’
And that is part of the problem about the future of healthcare in Britain. If members of the intelligentsia can be so blinkered about what is evidently wrong with this system, what hope do we have of improving something on which so many lives depend?
Former Conservative chancellor Nigel Lawson’s assertion that ‘the NHS is the closest
thing the English people have to a religion’ goes some way towards explaining the outcry that follows any rational suggestion that the NHS is broken and needs fixing.
Yes, it transformed public health and wellbeing in Britain — but even before Covid it lurched from crisis to crisis, despite repeated reforms and huge investment. It was letting us down.
Who wouldn’t agree there are too many highly paid managers? That job adverts for ‘equality, diversity and inclusion’ managers in the NHS are obscene, when some of these roles pay more than £75,000 per year — a far healthier salary than junior doctors or nurses take home?
That there’s been a shortage of midwives for over ten years, after 3,000 promised by David Cameron didn’t appear? That our attempts to reduce stillbirths lag behind those of Poland and Estonia?
That levels of waste and profligate spending (e.g. prescribing at great cost over-the-counter painkillers, when a pack of 16 paracetamol caplets is 29p in Aldi) are a disgrace? And so on.
The NHS is not a sacred cow. Like it or not, that bitter pill has to be swallowed if we are to have any chance of making things better.
THE National Health Service Act (establishing its structure) received royal assent in 1946, one month after I was born, and the NHS was founded when I was nearly two. So the bloated behemoth is as venerable and creaky as I am — and serious maintenance is essential.
That’s why all politicians should drop the dishonest sentimentality that prohibits discussing the NHS, and think of the welfare of patients instead of scoring points.
We need a new way to deliver healthcare in coming decades — when the demands will be greater even than they are now.
That was the verdict of the Institute of Economic Affairs back in 2003: ‘…the NHS was designed for the 1940s. Since then there have been three major developments which have directly affected the provision of health care. We have become an infinitely more affluent society, which means that people want, and can, afford to spend more on keeping well.
‘Secondly, the proportion of old people in the population has greatly increased and will continue to do so, which means that people need medical services for longer.
‘Thirdly, there have been huge advances in treatment which have mostly, but not invariably, increased its cost, often requiring expensive equipment and drugs.’
The problems have long been predicted. Yet politicians and campaigners parrot that we have ‘the best healthcare system in the world’. This was asserted by disgraced former health secretary Matt Hancock at the NHS’s 73rd ‘birthday’ in July.
Do these people take us for fools? We are the fourth-highest spenders on healthcare in Europe, yet routinely come near the bottom in terms of outcome.
The World Health Organisation says the French health service is the best in the world. We should learn from it.
A friend has a brother with a French wife. Pregnant and suffering swollen ankles she went to their English GP, who said nothing could be done. Back in France her doctor gave her anti-water retention tablets, an appointment with a physiotherapist and good nutritional advice.
And a young British woman I know living in France, expecting her first baby, said the maternity care was efficient, caring and she was offered every possible choice. I’m afraid she had a shock when she decided to have the baby in England, to please her parents.
Anecdotal evidence is one thing, but facts cannot be denied. Percentages can become tedious, but the French have more doctors for every 100 people and more hospital beds than us. As a percentage of GDP, UK healthcare spending was 10.2 per cent in 2019, but France spent 11.1 per cent.
(The only other EU country that spends the same as Britain is the Netherlands. Switzerland spends 11.3 per cent and Germany 11.7 per cent.)
Determined defenders of the NHS seem to think the only solution is to chuck yet more money at the problem, even though our taxpayerfunded model is as burdensome as it is inefficient. The French system is paid for partially by obligatory social security contributions, usually deducted from your salary.
France offers a high level of preventative healthcare (for example, not dismissing swollen ankles). Available services include addiction prevention, regular medical check-ups and the promotion of physical activity and healthy eating. France also has the lowest rate of heart-disease mortality in Europe.
When people go to see a family doctor, or have any other kind of out-patient appointment, they pay the cost of it — a basic consultation is ¤25 — but then about threequarters of the fee is refunded by their National Health Insurance Fund. (Patients on a low-income or who are sick long-term receive 100 per cent coverage.)
Would the British be so careless about appointments they demand as a right if they had to stump up and then get most (but not all) of the money back? Would it be heinous to require a small deposit on equipment such as crutches? I think not.
Before you protest, remember that in France people on very low incomes or who are not insured are covered. We can boast all we like about ‘our’ flawed NHS, but the French have arguably a better way of ensuring the principle of the common good.
Remaining in Europe for a moment, under German law, everyone must pay public health insurance. As of 2019, this amounts to 14.6 per cent of each citizen’s gross income, with the individual paying half (7.3 per cent up to a maximum monthly income of €4,538) and the other half paid by their employer. Deductions from salaries are automatic.
This covers every citizen’s primary care with registered doctors, hospital care (in- and outpatient) and basic dental treatment. It works.
Covid-19 threatened the globe but we should not let the panic it caused blind us to the fact cancer is the world’s second-biggest killer. It was responsible for 9.6 million deaths in 2018 — roughly one out of six everywhere — and the leading or second-largest cause of mortality before the age of 70 in more than half of countries.
An Economist Intelligence Unit report looked at the growing menace of cancer (in all its variations) and asked whether the world is ready to face it.
The subject is complex but the good news is that Britain comes second worldwide in terms of policy and planning — perhaps because of all those well-paid bureaucrats.
BUT the graph for care delivery is far more worrying. We are joint 14th with South Korea, behind (in order) Japan, the Netherlands, Germany, Australia, Spain, France, Sweden, Italy, U.S., Brazil, Colombia, Canada and Chile.
That is far from impressive. We all know it.
Anecdotal evidence of a broken system abounds. I know a mother in her early 40s who, failing to obtain joined-up care (in a very prosperous area) for a terrible flare-up of her chronic medical condition, was driven by neglect to make four 300-mile round-trip journeys to an area where a senior anaesthetist friend ensured she got treatment from a sympathetic consultant.
That should never be necessary in a wealthy nation like ours.
Small, individual moans and cries about NHS shortcomings and failures combine into a shocking crescendo nationally.
Yet that noise, which urgently demands to be heard, is routinely shut down — silenced like a shushing in a church by the pious ones who keep their eyes tightly closed.
This cannot go on. If as a nation we wish to show pride in our healthcare system in order to bequeath it in good nick to our grandchildren, we must now (postCovid) insist that politicians work together towards radical reform. But that would require trusting them with an enormous task — and frankly, I don’t.
We need an independent Royal Commission — an inquiry at the highest level established by the Queen at the behest of the Prime Minister — to delve deep into the problems that confront us today.
Then it should come up with a set of recommendations that will enable us to confront 21stcentury challenges.
This is, after all, a matter of life and death.