We need to talk about the NHS

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?