How many more Staffords before we
seriously consider NHS breakup?

Probably one of the most underplayed points of agreement between many Liberals and Conservatives is support for breaking up the NHS.

It’s a little-known fact but, in 2005, then-MEP Nick Clegg declared “We do want to break up the NHS” because “frankly the faults of the British health service compared to others still leave much to be desired.” Becoming leader of the party of course put pay to that idea but Clegg is at heart, like many of his fellow Lib Dems, a classical liberal.

Despite this party plurality, however, the ‘tyranny of the status quo,’ as Daniel Hannan would put it, remains doggedly enthroned in the minds of Britons. No matter how many NHS scandals like that of Stafford Hospital erupt, exposing the neglect, cruelty and incompetence endemic to this most socialist of healthcare systems, it remains a sainted institution for which criticism of its continued existence borders on heretical.

Sadly, so long as Labour, some Liberal Democrats and David Cameron are around to score political points by frightening people with horror stories of an ‘American-style’ system whereby those without insurance are thrown into the streets (this doesn’t happen), or harp on about the dedication of NHS nurses (would they be less dedicated under a different system?), the sometimes short-sighted people of Britain will not care to consider the highly efficient and far more successful health systems of nations as close as France and Belgium.

In both those countries, there is a far greater mix of private, state and charitable provision with citizens generally being reimbursed 70% of their healthcare costs by the state with the option of a ‘top-up’ to 100% through membership of a mutual insurance company. State-funded health insurance, rather than a state-managed health organisation, is the norm on the continent with, of course, great diversity in the detail.

Yet tellingly – as pointed out in this informative if not always accurate Guardian article (Couverture maladie universelle is not an ‘equivalent of the NHS’) – Belgian healthcare was rated one of the best on the continent by expatriate site because of competition between mutuals – and France’s was named best in the world by the World Health Organisation.

Europeans generally spend more as a percentage of GDP than Britain on healthcare but, given the vastly greater results, is this really a bad thing? Higher healthcare spending is generally greeted with enthusiasm by a public happy to cough up for better health but, as evidenced by the Blair/Brown years, the Stalinist, top-down, state management of the NHS ensures no amount of treasure thrown into its gaping jaws makes any significant impact on outcomes. Cancer survival rates in the UK, for example, remain embarrassingly low in comparison to other developed countries.

Despite being so often reminded of the metaphorical narrowing of the Channel, however, this remains a curious blind spot in British politics. Tony Blair pledged to match European levels of spending on health in 2001 yet, again, any discussion of how this cash is actually spent in Europe was avoided. As such, the UK health system continued to be governed by ministers and tier upon tier of managers. Worse, no Conservative leader, let alone prime minister, has ever dared broach the subject.

That it has taken senior Liberal Democrats including David Laws and Nick Clegg to hold a serious public debate about breaking up the NHS in the past is highly disappointing. More disappointing, however, is the latter’s abandonment of this policy in government for a populist ‘we’ll save the NHS from the Tories’ stance.

With a generally greater interest in European affairs than most parties, Lib Dems have always been in a good position to compare systems and, certainly in the past, were generally given the benefit of the doubt on such issues for the simple fact of not being Tories. The party’s spell in government may be changing this but the fact even ‘social liberals’ in the party have attested to the superiority of European health systems (see pages 8-9 here) is testimony to an enormous failed opportunity.

The sad thing is, many Conservatives also allow their distaste for the EU to blind them to the many things European nations, individually, can teach us about how to properly run social institutions. And, while I would always argue EU membership is, on balance, of great detriment to the UK, it is worth remembering the European Community was for many decades Labour’s bête noir because of the belief competition laws would one day necessitate the breakup of the NHS.

Particularly in these austere times, there is only a finite amount of money government can throw at the NHS; only so many wasted reports and consultations about top-down reorganisations before it becomes apparent the whole apparatus must be broken up

But, most of all, to continue to defend a system that so lets down its benefactors – even to the point of abuse – is an affront to human dignity and reason. It’s time for a grown-up debate and this government must grasp the heretical nettle and spark it.