The NHS clearly isn’t the envy of the world

Coronavirus has exposed its inflexibility and overcentralisation – other countries have done better

The coronavirus pandemic has had two effects on British perceptions of the NHS. On the one hand, it has reinforced admiration of the staff. Nurses, doctors and other personnel have been like soldiers going into battle. They have got close to patients infected with the deadly virus and knowingly accepted a high risk of catching it themselves. The Government acknowledged last week that 19 NHS staff have died and that number is undoubtedly higher now. Our clapping of NHS employees has been heartfelt and is well-deserved.

At the same time, another perception has been brought home to us. For many years, public debate about the NHS has been conducted as if there were only two healthcare systems in the world: the NHS and the American one. The US system has been depicted as heartlessly demanding to see your credit card on arrival in hospital and, in the absence of one, turning you away. Not surprisingly, the NHS emerged in these debates as a preferable system.

But the pandemic has been a vivid reminder that there are hundreds of other healthcare systems and that many – or even most – have performed better than our own. Of course, it is early days and it will be a long time before a final reckoning is possible, taking into account the age profiles of different populations, the density of how they live and such factors.

But on the latest figures, the bald fact is that Britain ranks fifth worst in the world in deaths per million, coming after Spain, Belgium, Italy and France. We have become painfully aware that we have been behind the world in testing, too. Britain is struggling to build up to 100,000 tests a day by the end of this month, whereas Germany was conducting 116,000 tests a day two weeks ago.

We entered the crisis with a lower proportion of intensive care units per capita than other countries and fewer ventilators. The more we admire and want to protect the NHS staff, the more we should be disturbed by the way that the NHS has not always managed to provide protective equipment for them. It is embarrassing to hear the Government resort to the excuse of “logistical problems” for this failing when other countries have overcome such issues. We find ourselves a charity case, being given a million masks by Taiwan.

Taiwan, along with South Korea, Singapore and Hong Kong were all much closer to the source of the virus in China. To begin with, South Korea was one of the countries worst affected. But all these countries have managed to contain the spread of the virus to a remarkable degree.

British deaths per million have been 190 so far. In these countries the figures have been 0.3, 4.2 and 0.5 respectively. In due course, their figures may rise. But they have, at the least, bought time in which the researchers of the world may be able to develop an antibody test, find treatments and, eventually, create a vaccine.

In the short term, admiration for NHS staff understandably overwhelms all else and we have to face the crisis as best we can. But when things have settled, we owe it to those staff, as well as ourselves and those we love, to look more closely at other systems. A truly independent inquiry with experts from around the world should be established to see where the NHS did well and where it fell short.

The most notable characteristic of the British system is that it is the most top-down, centralised one of any advanced country. In contrast, in Germany, 132 laboratories – publicly owned and private – got testing quickly. Their system is based on compulsory, individual health insurance which everyone has. It is diverse in its organisation and ownership. This diversity has endowed it with a flexibility and readiness to innovate that is not so easy in our command and control system.

I have just emerged from having 10 days of Covid-19 symptoms. It was, to be honest, scary: the first time in my life that I have thought it possible that I might die imminently. Believe me, that kind of experience makes one want Britain to have the best possible healthcare system, regardless of all prior tradition or prejudice.