NHS’S poor prognosis

The countdown continues to next week’s 70th anniversary of the foundation of the NHS. Yet with every passing day, what was intended to be a great celebration has turned into long-overdue, forensic scrutiny of the outcomes the health service provides.

A major new study shows that the UK performs worse than almost any other advanced country in the prevention of avoidable deaths and below average in the treatment of eight of the 12 most common causes of premature demise. The NHS also has fewer doctors, nurses, hospital beds and scanners than other countries and the UK spends a smaller proportion of national income on healthcare. As Paul Johnson of the IFS think-tank puts it, “By international standards it is a perfectly ordinary healthcare system, providing average levels of care for a middling level of cost.”

How is it that an institution often called the “envy of the world” continues to perform so badly? Moreover, how can we continue to pour more money into it without some root-and-branch reforms of the way it is structured and funded?

The problem is that the NHS was set up along the lines of a nationalised industry, designed to equalise access but not maximise performance. It was a creature of the post-war drive for socialised services. Yet despite the passage of time, all fundamental reform is rejected. The founding principle that treatment should be free at the point of delivery rules out charges which would help raise money and change the internal culture that leads to waste. The BMA yesterday rejected a proposition that GPS should charge a modest sum for consultations. For as long as we regard the NHS as inviolable it will never get better, only worse.