The NHS was once seen as heroic. Now it’s a national embarrassment

With so many suffering unduly, Britain must urgently pursue ways to revitalise the service

Between 1975 and 1977, the Labour government closed more than 100 NHS hospitals. Most of them were charitable and municipal hospitals that predated the NHS. Did the removal of thousands of beds from our health-care system diminish the faith of the British public in the NHS? No, it did not. It was still regarded as “the envy of the world”.

Then, at the turn of this century, international statistics on cancer survival rates were published. They showed that the number of people in Britain still alive five years after being diagnosed with cancer was significantly lower than in other European countries. Professor Karol Sikora, a cancer consultant, calculated that 10,000 people a year died in Britain who would not have done if they had been in an average European country. Did this destroy faith in the NHS? Perhaps it made a little dent. But the opening ceremony for the Olympics in 2012 still featured a paean of praise to the NHS. Things carried on as before.

The widespread view remained that the NHS was sacrosanct – a symbol of how wonderfully – even uniquely – humane Britain was. People did not want to know that its performance was inferior to that of other systems, and clung to the hope that some tweak here or better management there would solve the problem. Or maybe just more money.

Now, the failings of the NHS are in focus again and this time I believe there is a modest but distinct shift in attitudes. More people have reached the point where they feel “this just isn’t working”. The change has come about because of millions of bad personal experiences.

The letters pages of the Telegraph last week contained one story after another of individuals waiting for GP appointments or in A&E, sometimes with terrible consequences. One reader in Wales wrote that she needs injections for macular degeneration in her eyes every six weeks. But 10 weeks had passed since her latest injections and she was not able to get an appointment. She woke up each day wondering whether her eyesight had deteriorated further. Naturally, she must fear going blind.

It is a small sign of the times that the London Evening Standard last week carried an article describing how much better health care is in Australia. Even the Guardian has been obliged to report relentlessly on NHS waiting times and failures.

Many people will think: “Yes, that is probably true. However, we can never change or reform the NHS. It is politically impossible.” But who knows what is politically possible? In the 1970s, it was “politically impossible” to tackle the overwhelming power of trade unions. Yet it was done. It was also “politically impossible” in the 1990s to reform welfare benefits, and certainly unthinkable for a Tory government to do it. And yet, to a remarkable degree, this was done, too.

The NHS has seemed a nice – even heroic – idea, but too many people are now waiting, suffering, and dying because of lack of treatment. We may have reached the point with our health service where it will become politically impossible not to reform it. How might it be done? It so happens that something similar has been done before.

The Netherlands once had a health-care system comparable to ours and suffering from the same sort of problems. The waiting times were bad and there were instances of waste and mismanagement. In 1986, a commission was appointed to report on the system. It recommended a compulsory health insurance system with less central government control and more competition between private suppliers. The report was hugely controversial and did not lead to any immediate reform. Yet it remained as a big fat elephant in the room that could not be ignored indefinitely. Eventually, after many years of debate and a great deal of consultation with the medical profession, a new system of health insurance was created in stages. It might not be the best health insurance system in Europe – the German and Swiss models are probably superior – but it is a great improvement.

If we tried the Dutch model – starting off with a major report on the performance of the NHS, perhaps even a Royal Commission – the same process of debate and eventual realism could take place here, too. The advantage of this approach is that it encourages widespread involvement and ultimate consent. The drawback is that it could be slow. It took two decades in the Netherlands to get from the commissioning of a report to a new system.

The alternative is to try to get going now by making incremental changes.

These could include copying techniques that are already in place in other countries. In Australia, higherrate taxpayers are required to pay a special surcharge if they do not take out private health insurance. The idea is that high-earners can surely afford to pay for their own health care and should do so, freeing up the capacity of the public health-care system to serve everybody else.

Another idea deployed in Australia and elsewhere is to allow patients to go to see any general practitioner they want – not just the one they are registered with. If you can’t get a timely appointment at your usual surgery, you can get one elsewhere. We could do the same and simultaneously remove any remaining restrictions on GP practices being set up in competition with each other.

In Singapore, everybody of working age is required to set aside some of their income into a personal savings account that can only be spent on health care. This means that when people need medical treatment, they can choose exactly where to go and there is active competition for their business. These are just some of the ways to shift the balance to a more mixed system of health care.

One of the keys to the reform of welfare benefits in Britain was the way it was framed as being needed not as a matter of doctrinaire policy or of disapproval, but as a way of improving blighted lives. Similarly, the reform of our health-care system should be framed as finding ways to reduce suffering and prevent unnecessary deaths. We are a caring country. The way to show we care now is to reform our health care.

In Singapore, everybody is required to pay some of their income into a savings account that can only be spent on health care