Ever since its inception, the European project has been dominated by a partnership originally inspired by reconciliation but now predominantly borne out of stone cold realism.
The Franco-German motor that has driven the European Union has been largely unshakeable. Today they may disagree over macroeconomic policy but in reality they know their best interest lies in keeping the other sweet.
In their eyes, the loss of their axis would allow for a genuine intergovernmental project, based on respect for state rights. Everything from the Common Agricultural Policy to the euro currency has come about because these partners wanted it or because one gave into the other. What hope is there for those countries, like the United Kingdom, with the economic clout and manpower, but with no shoe in the Franco-German door?
When the UK acceded to the European Economic Community, economic cooperation and prosperity beckoned. Less than two decades later, the United Kingdom was subsumed into a Union, by Brussels and the Major government.
Brussels has become the vehicle for the motor and it would be stupid to deny both France and Germany have as much influence in the Belgian capital as other member states – they have considerably more. Caught between French and Flemish speakers, one can’t help but feel you’re the filling in a Franco-German sandwich.
Even in the parliament, it is a widely accepted fact that the German EPP holds the ‘big boy about town’ crown and the French MEPs consistently succeed in halting any attempts by the other 600-odd MEPs to abolish the seat at Strasbourg. To believe these partners have been successfully subdued with phases of enlargement is to also considerably miscalculate a reality.
If the UK wants to remain part of the European project, what can it do to alleviate the collusion at the heart of the continent? My answer is to ‘Go East, young man’.
Margaret Thatcher never gave it a thought, John Major never had the time to. Tony Blair pondered it and pushed it (briefly) and Gordon Brown forgot it. Now, David Cameron fails to seize it. If the UK wants to be a major player in Europe, no longer on the edges nor batting all over the field, it has to make friends.
This process does not have to involve forming an alliance founded on a similar ideology or common opinion of the European machine. It simply needs to promote relations and ties. The United Kingdom has neglected Eastern Europe – it does not take an interest.
These countries have shed communism and are now energetic to participate in the European political project. They are worthy enough to thrash their ideas out in the Parliament or the Council and should be listened to.
The UK has a role to play – its role doesn’t involve lecturing or looking down upon those countries that have not been blessed with (or spared!) a thousand-year old monarchy and ancient parliament. The UK would do well to remember that our past has not been one glorious climb.
Our role involves treating these countries as our partners, improving our knowledge of these lands and offering the hand of genuine friendship with no strings attached.
Sure, these nations reserve the right not to shake our hand or return our efforts of friendship, but we must at least try to show that we are of the European continent and that we are here to trade, learn and exchange ideas with countries we consider not only our neighbours, but also our friends.
France, for instance, shares a greater affinity with Eastern Europe than we do, but with time and effort we can strive for the same kinship. Let’s not rush for the Atlantic exit just yet. Let’s fight to win hearts and minds.
By Dominic Trynka-Watson
The NHS is often held up as the greatest achievement of post-war Britain and frequently termed ‘the envy of the world’. Indeed, the NHS as a system enjoys an unusual status whereby it is insulated from criticism by proponents across the political spectrum, who seem to imagine the sole alternative is a dystopian one where those who cannot afford insurance due to low income or pre-existing conditions are condemned to suffer and die.
As such, those who dare to criticise the system are rarely allowed to have a rational discussion on the topic. They are instead pilloried as uncaring, their motives assumed to be sinister, branded insulting to healthcare staff and even unpatriotic. Even discussing it among friends or family rationally can be remarkably uncomfortable as people almost invariably have an emotional response and make loaded statements along the lines of ‘X wouldn’t be alive today if it wasn’t for the NHS’.
Indeed, I have previously been accused of hypocrisy as ‘I would not be alive today without the NHS’. It is perfectly true that without access to healthcare I would have almost certainly died as a young child, but it is manifestly false to suggest that the NHS is the only healthcare system in the world that would have given me that care. Indeed, there is no developed country on Earth where I would not have received the attention I needed. Even in the US – frequently held up as an example of the aforementioned dystopia – had my parents been uncovered and unable to afford my care, Medicaid would have covered it.
I do not imagine that there is an adult alive in the UK who does not know someone who would be dead, or suffering a far poorer quality of life without healthcare which they have received from the NHS. Nor would I question that there are many places in the world where healthcare is objectively worse. However, the vast majority of those places are developing nations where healthcare spend per capita is lower.
The obvious exception is the US and it is easy to understand how that corporatist nightmare of a system would inspire a deep suspicion of the profit motive in healthcare. That said there are numerous healthcare systems in the world which perform better than the NHS and I doubt that there are many people in the UK who lack some anecdotal evidence of the NHS’s shortcomings.
We should not be content to be mediocre amongst the advanced nations of the world and we need to start by accepting that, at the present time, we are. Before a rational debate on the future of healthcare in the UK can be had, proponents of the NHS need to accept this and the fact most critics of the NHS are not just ideologues nor have sinister motives, but have a genuine desire to improve the quality of healthcare in this country.
Regardless of their personal experience or that of family or friends, it should be self evident to anyone who reads the news that the NHS is not perfect. The problems at Stafford Hospital which are thought to have contributed to the deaths of around three hundred patients being one of the most significant recent examples. The most striking aspect of those stories is of course the tragic loss of life and the harrowing tales of neglect, but almost as depressing is the cover up and the lengths families have had to go to get answers. I cannot help thinking that, if not for the majority’s deference for the NHS, the failings at Stafford would have come to light earlier – thus saving lives.
Even on a more basic level, the NHS has serious problems, such as a lack of accessible out-of-hours GP services and long waits for appointments. Recent reports on the My Medyk clinic set up by Polish doctors in west London were notable, not just because of their extraordinary success, but because many of their patients are not the wealthy people we typically imagine going private, but modest working people, both British and migrant, for whom the fees are a significant expense, but feel compelled to seek attention privately because of the delays and poor care they have experienced in the NHS. Most telling are the unfavourable comparisons from some Eastern European migrants to the systems in their homelands.
Then there is the elephant in the room; the cost of the NHS. This is often the most infuriating aspect when trying to discuss the NHS. Proponents often seek to dismiss problems within the NHS as being down to resources rather than the system. Yet expenditure on the NHS has risen rapidly and consistently since its inception. Another noteworthy news story of late is that the BMA consultants’ committee have said that there is a pressing need to define ‘core services’ to be funded through taxation and for top-up fees to be charged for other services.
This surprised me somewhat as the BMA rarely deviates from NHS orthodoxy but it is a perfect example of the sort of ideas that we need to be considering. However, we need to look much deeper. Such a mechanism is one way of managing the increasing cost of healthcare in the UK but does not address the root causes. There are causes which we cannot address – the obvious one being our ageing population, but this makes it all the more important to address the ones we can if we are to have an affordable and effective healthcare system in the future. The BMA might be far less comfortable discussing why GPs in France – a nation whose healthcare is consistently ranked as better than ours – earn on average less than half the amount of their UK counterparts.
I will be honest, I do not know how to ‘fix the NHS’. Indeed, it would be arrogant of me to think that I possess a fraction of the expertise needed to settle on the best way forward, I doubt any one person does. But my instincts are that we should be looking closely at the likes of France and Singapore. Those two countries have superficially similar, but in detail quite different, systems with a mix of government funding, insurances and patient fees.
France achieves some of the very best health outcomes in the world (and I would add is the easiest to access and most efficient healthcare system I have ever had occasion to use) and Singapore does almost as well at a much more modest cost. I do not doubt that somewhere between the two lies a balance that would be the best way forward for the UK. What worries me is that we as a nation are not even close to being ready to discuss the matter, let alone act. How many more Mid Stafford’s will it take before we are?
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 Expatia.com 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.