Which party will be brave enough to open the discussion, on a new financial form of health service provision, and be honest about what cannot be provided? Otherwise we progress to a No Hope Service in each post code / jurisdiction. The Times completely missed out the need to ration overtly, and that technology is advancing faster than any government’s ability to pay.
On June 28th the Times leader opines: Health Disservice
It is six years since Danny Boyle turned the NHS into an object of quasi-official mass veneration at the London Olympics’ opening ceremony. When 300 luminous beds spelt out its initials in the stadium the message was clear: Britain considers its health service the envy of the world and anyone who does not agree is just plain wrong. Before the Olympics there was already a strict political taboo against challenging the basic purpose and funding mechanism of the NHS. Since then, the taboo has endured as the service has lurched from crisis to crisis, never solvent, sapping staff morale and failing to deliver the world-class care that taxpayers are led to believe they can expect.
At present funding levels they cannot expect such care. Nor do they get it. An estimated 10,000 British cancer patients a year died early a decade ago because of late diagnoses, and the number has scarcely fallen since. The NHS has fewer than half as many scanning machines per head than the average for 11 comparable countries. It has one doctor for every 356 people compared with an average in these 11 countries of one for every 277.
NHS care is not bad overall, but it is mediocre. Despite this, as the 70th anniversary of its founding approaches, parliament is full of politicians wearing outsized NHS lapel badges as if they were party rosettes on election day. Theresa May knew she would be expected to find more money to mark the anniversary and duly announced an extra £20 billion a year by 2023, without explaining where it would come from or how it would be spent. No other area of public spending could expect such largesse or such a willing suspension of critical thinking.
The principle enshrined in the NHS charter, that care should be free at the point of need, is noble and valuable as a broad goal. It is also the reason the service retains such high levels of public affection despite its failings. But enshrining anything is bad policy. The NHS is not a religion. It is an overburdened public service too bureaucratic to be truly efficient, too big to cater to the individual rather than the herd, and too preoccupied with the critically ill to do a better job of preventing people getting ill in the first place.
The best 70th birthday present for the health service would be an admission from a sitting prime minister that there is a reason why no other rich country has adopted the British system. As populations age and the treatments available to them become ever more expensive, paying for them out of general taxation ceases to be possible.
One undoubted NHS strength on which all contributors to the latest international survey could agree is that it protect patients from financial calamity should they fall gravely ill. The importance of this safety net function should not be underestimated, but even a left-leaning US health think tank that consistently praises the NHS in principle admits that in practice it ranks last among comparable systems for keeping patients alive.
It is not enough to be content with equitable access to healthcare. Outcomes matter too. Most alternative systems that do better at restoring cancer and heart disease patients to health spend more per capita than Britain, but the NHS also suffers from fundamental cultural failings.
Studies suggest that those who pay for it often feel unwelcome at its surgeries and hospitals unless they are severely ill. Their reluctance to see a GP, and GPs’ reluctance in too many cases to refer, are the crudest sort of efficiencies. When cancers go undetected as a result, such efficiencies cost lives. Mrs May has said that she is willing to reverse the last government’s least successful reforms if the health service can suggest genuine improvements. There are no easy answers, but there is a vital rule of thumb: no sticking plasters. Sooner rather than later the NHS needs to be rethought from the ground up.
Sir, As a retired GP deeply concerned about the welfare of the NHS, I concur with Graham Smith’s letter (“Healthcare models”, June 28). Politicians need to grasp the nettle and admit that the present model of the NHS is unsustainable. Other models, while not perfect, are vastly superior to our system. In Switzerland, for example, no one who cannot afford healthcare is excluded. Instead they are served by the state, thus maintaining one of the foundational principles of the NHS. We collectively need to have grown-up conversations about what we want and can afford. Who among our politicians, I wonder, has the courage to start such?
Dr Anne Aitchison
Sir, Your leading article on the NHS (“Health Disservice”, June 28) draws on data presented by my organisation and other leading think tanks. Yet its conclusion that poor outcomes on some of the big killers such as cancer are down to the tax-funded nature of the system is spurious. In fact, there is no reason to think that the funding system is part of the reason behind our poorer outcomes. Several other countries that do better on saving lives — such as Sweden and Canada — also have tax-funded systems.
Our below-average survival rates from cancer and other killer diseases are likely to be due to a combination of reasons, including fewer doctors and nurses and less provision of vital equipment. But the way health systems are run and operated also plays a crucial role. Few other health systems, including those modelled on the NHS, are as highly centralised and politicised as the health service in England. Perhaps the best birthday present we could give the NHS is to swap our obsession with how it is funded for a healthier obsession with improving our clinical outcomes.
Chief executive, Nuffield Trust
Sir, I applaud your leading article: the NHS really must be reimagined. However, you do not address the thorny issue of how. Insurance schemes are one possible alternative. Countries such as France, Norway and Germany, which have not adopted the NHS model, have such schemes in place alongside outcomes that make some of ours look shameful. Yet in the UK the very mention of health insurance can invoke incendiary reactions. It is high time we began a brave and open-minded debate about our NHS and took a close look at how other countries do healthcare.
Sir, People often do not appreciate something they get for nothing. In New Zealand and Australia, patients pay for GP visits; in Australia we get back about two thirds of the cost from Medicare, although poorer patients can visit a GP without charge. We can also visit more than one GP if we wish and it is our choice whether we go to one who is covered by Medicare or pay extra to go to a doctor who charges a little more.
Halls Head, Western Australia
Sir, I fear that Graham Smith may have shot his own argument in the foot. If, after 70 years, the best minds in healthcare have been unable to come up with a successful “reform” plan (and there have been many such reorganisations) then it is unlikely that any other great minds will be able to do so in the next 70 years.
Rather than focusing on changing how the NHS does what it does, we should be looking at what the NHS should not do. There is a good deal of “futility medicine” in the present system; just because we can do some very clever things does not mean we should. A review based on that premise would have some chance of success.
Dr Andrew Bamji
Rye, E Sussex
Sir, Melanie Phillips is right that there are better models of health care than that offered by the NHS (“The elderly deserve better than NHS care”, June 26). It has been clear for years that the present model is unsustainable, given its perpetual crises and insatiable demand for more money. Yet politicians of all parties have deferred any proper reform, resorting to pointless organisational tinkering allied to occasional splurges of money. The NHS is far too big an organisation and, as Phillips makes clear, is “an instrument of arbitrary and unaccountable power”. It is also, as reported by you on the same day (“NHS is way down international league for healthcare”) not very good at its job, notwithstanding the efforts of many brilliant staff.
The time has surely come for a comprehensive and bipartisan review of the NHS, with a systematic consideration of major healthcare systems around the world and a wide-ranging look at funding options. This review should examine whether there is a better way of structuring health care in the UK and make detailed recommendations. The usual objection to this is that it would take too long. This is nonsense. The NHS has been around for 70 years; we can wait a few more years for some well-thought-out ideas as to how it should be structured for the next 70 years.