Happy birthday, NHS – but we must be more honest about its failings
Published by the Evening Standard (5th July, 2018)
After an orgy of self-congratulation, the big day has finally arrived as the National Health Service celebrates its 70th anniversary. It is hard to think of any other state body that would generate such rose-tinted hullaballoo. But there is one simple present we should bring to the birthday party: honesty.
While some boast that the NHS is the envy of the world, the painful truth is that it is significantly worse than rival systems at its key task of keeping people alive. It performs badly when compared with other rich nations on preventing deaths from heart attacks, strokes and the most deadly cancers. It even has higher mortality rates for babies in their first month of life — and this is not just down to cash.
Britain’s worship of a creaking public service has impeded a proper focus on profound issues of safety, outcomes and efficiency that often impact disastrously on our most vulnerable citizens.
As the father of a young woman with complex disabilities, I have seen the service at its most impressive and supportive best — but sadly, I have also seen the dark side of medical arrogance and crass mistakes. As a journalist, I have heard from too many other families failed by the system — and from whistleblowers crushed when speaking out to improve services.
Our NHS debate, focused so remorselessly on finance, is dogged by complacency. Yet a report last week by four respected think-tanks asked ‘How Good is the NHS?’ – and after comparing Britain with 18 similar nations, the conclusions made gloomy reading.
The NHS delivers lower than average life expectancy with lagging survival rates for at least eight of the 12 most lethal modern diseases. We have among the worst ‘amenable mortality’ levels — when people die from potentially preventable conditions. This means 117 out of every 100,000 Britons died avoidably in 2015, compared with only 78 in best-performing France.
Labour loves to shout about a Government it claims is bleeding the NHS dry. Yet the gap in cancer survival rates has closed slightly since Conservatives moved into Downing Street, while low suicide rates indicate mental health services may be better than suggested.
Discard the United States — which blows by far the biggest share of national income on health despite hideous inequalities and low life expectancy — and the report finds Britain spends almost the average for richer nations. Our waiting times are also in line but we do have fewer doctors, nurses, hospital beds and vital machines such as scanners.
Despite Britain’s devotion to the NHS, there is little unique about universal healthcare in developed countries. But they struggle to fund it regardless of their system, since they are victims of success caused by some amazing medical advances.
This means people live longer. It means more citizens survive with complex, multiple and costly conditions. And it means we must move on from a post-war system designed for a different age, when tackling industrial injuries and infectious diseases was the priority.
The promised £20 billion cash injection for NHS England over the next five years is welcome but little more than sticking-plaster politics. For this massive bung is less than both average spending rises over the body’s history and annual health inflation.
This should be the start, not the end of our health debate. The splurge will spark higher taxes but not solve deep-seated problems inflamed by spiralling demand.
Last year almost three million more patients went to Accident and Emergency than in 2010, while doctors performed 2.2 million more operations, and specialists saw almost a million additional cases of suspected cancer.
These spectacular figures are a huge credit to hard-pressed staff. But Britons must accept that their NHS — already costing almost three times the defence budget — is far from free.
I favour a dedicated tax to show people how much the service costs in their pay packets. Although just a cosmetic change, it might shatter some illusions and spark sensible debate.
We should discuss concepts of personal responsibility, challenge the corrosive effects of risk-averse bureaucrats, slash red tape, empower frontline staff and examine paying for basic services such as seeing doctors or spending time in hospital, as in neighbouring nations.
This might sound controversial. Yet patients seem relaxed now about prescription charges that once provoked NHS creator Aneurin Bevan to flounce from the Cabinet.
Then there is social care, the poor relation left badly wounded when austerity was overloaded on local authorities. This leads to horrendous bed-blocking in hospitals. But why does someone dying of brain cancer get free treatment but not someone dying of dementia? This is a false distinction.
The NHS is comparatively efficient, but resources still get wasted. Last month Health Secretary Jeremy Hunt told of one hospital with 17 computer networks, each needing staff to input the same data, while the NHS is the world’s biggest buyer of fax machines.
There is a big variance in prices paid for surgical parts, yet too little data shared on impact. When one hospital was briefly privatised, incredibly it saved £3 million in procurement costs in two years by ordering its own supplies rather than relying on NHS bulk purchasing.
Yet talk of privatisation provokes boos and hisses in Britain, although it is common in better European services. Again, this shows an infantile level of health debate, when the focus should only be on the most effective clinical results, patient safety and equality.
Whatever the solution, if Britain really wants its beloved health service to celebrate many more birthdays, citizens must recognise its faults and stop treating it like a sacred cow.