I have included Clare as a “guest” as she says it all. She is partner to someone else who almost certainly thinks the same – as almost 70% of the medical professions do. There will always be a minority of “deniers”, but the services in the UK are meant to be for us all. Instead they are 4, and only for those living near tertiary centres and in affluent neighbourhoods. The regressive nature of this pandemic should let us reorganise the societies we live in.. Lets hope.. NHSreality wonders if talking about change is contagious in itself, and this is why the politicians wont do other than mouth platitudes.
Clare Foges opines in the Times 2nd May 2020: Don’t let faith in the NHS blind us to its faults – We rightly praise the heroism and sacrifice of health workers but must face up to the need to reform a creaking service
The Thursday evening ritual: clappers and cheerers, whoopers and pan-clangers — now curtain-twitchers and snitchers. Last week a woman took to Mumsnet to describe her anguish at being outed as a no-show for her street’s “Clap for carers”. After a rough night with her infant she fell asleep early, thus failing to turn up on her doorstep. A serious error. One noble-hearted neighbour took to the community Facebook group to name and shame this NHS traitor, declaring that if she couldn’t spend a minute showing her appreciation, she and her family did not deserve to use the health service. Laggards beware: get a rainbow up in your front window quick, or expect a brick through it!
It’s right that we applaud NHS staff who risk their own health for others (reader, I am married to one of them). Yet the shaming of this Mumsnetter captures something beyond gratitude to doctors and nurses; a reverence of the organisation itself that has become cult-like. How feverish our nation’s devotion to the NHS has become, and how far we are from the possibility of rational debate on its future once this is all over. Coronavirus may do serious damage to the NHS — not by overwhelming it, but by elevating the institution to such heights in the public’s affection that it is beyond discussion, beyond necessary reform.
The pride has long been fierce, and rightly so. In 1948 a leaflet dropped through millions of doors, wrapping a radical idea in plain language: “Anyone can use it — men, women and children. There are no age limits, and no fees to pay.” Imagine the force of this leaflet in the hands of someone wearied by poverty, a lightning bolt of compassion through the letterbox. In the decades since, as other institutions shrink or shut, we cling to the NHS as evidence of British greatness. It is, as the former chancellor Lord Lawson put it, rather like a religion and we worship with a fervour that surprises those abroad. The homage to the NHS in the opening ceremony of the 2012 Olympics had viewers overseas scratching their heads; one US paper found “the dancing sick-kids salute to the National Health Service . . . more than a bit bizarre.” Meanwhile, we were moist-eyed, thinking of the babies born and bodies mended thanks to strangers in scrubs.
I share the pride but am uneasy with the zealotry. This religion allows no doubters. Criticising the NHS is blasphemy; questioning the way it is run heresy. On the 70th birthday of the NHS a few years ago, a poll found that 77 per cent believed the NHS “should be maintained in its current form” — not, I imagine, because they think the status quo is perfect but because change of any sort has been cast as the slippery slope to destruction, privatisation, and Richard Branson cashing in on your gall bladder removal.
Faced with such devotion — and paranoia — politicians are left with little choice but to mouth platitudes. Those who attempt reform are attacked. Those who propose changes must be secretly plotting to flog our health service. A sensible conversation about improving the NHS is all but impossible.
All this was true before the pandemic. Coronavirus will only deepen the adoration and make rational debate more difficult. Boris Johnson’s rather moving speech after his hospital stint captured the mood: “The NHS is the beating heart of this country; it is the best of this country. It is unconquerable . . . ” His tribute veered between individual NHS workers and the NHS itself, blending the two, and this is part of the problem; if workers are seen as the embodiment of the whole organisation, any criticism of the NHS can be cast as an attack on doctors and nurses, pressing the button of public outrage. Yet it is possible to praise the job health workers are doing, especially now, while questioning whether a system designed in the 1940s is fit for today.
The NHS in its current state is far from the communist catastrophe some critics claim. Care in many fields is excellent. No one is put off treatment by the threat of penury. Yet across 8 of the 12 top causes of death in wealthy countries, such as heart attack, stroke and cancer, our outcomes are worse than average.
When it comes to reforms and where they may take us, the rapacious American system is always held up as the only alternative to ours. But look to Europe. In Germany, which has a compulsory insurance system with access to many private hospitals, treatment is so fast that they don’t bother to collect data on waiting times. In France, the journey from diagnosis to operating theatre is so swift that a couple of years ago, overstretched health services in Kent were sending patients across the Channel for treatment. In Sweden the organisation of care is radically decentralised, with 21 county councils raising 70 per cent of funds.
True, we spend less than these nations, and I would argue that a greater chunk of our GDP should be spent on healthcare. But a sensible conversation about the future of the NHS would go beyond money to explore what works to deliver efficient, fair, life-saving healthcare around the world: allowing more private providers to enter the system; merging health and social care systems; introducing small (and possibly reimbursable) charges for visits to the GP or for minor investigations.
Along with most of Britain I would die in a ditch to preserve a health service that looks after people regardless of how much money they have. But how we pay for, manage and deliver this should be open to debate. If we truly love the NHS, we must be willing to talk about how to improve it.
Update 4th May 2020: The Times letters
Sir, Clare Foges (“Don’t let faith in NHS blind us to its faults”, Comment, May 2) makes the excellent point that we should separate our admiration for the people working in the NHS from the organisation. We must maintain the ability to look critically at it.
The pandemic has drawn the public’s attention to the health services of other countries, and their outcomes, in a way that allows us to make comparisons that would not normally be so visible. Those tempted by the American style have seen the reality of a rich country’s choice not to provide universal healthcare. I am a GP not a health economist, but I am struck by the results from Germany, which emerges looking effective and efficient by way of a compulsory insurance system combined with state funding. The mood of the public is at a peak for accepting changes that will benefit the country as a whole, rather than satisfying one political party. Now is the moment to overhaul the way we pay for health in the UK. We do not need five-year investigations, let’s seize the moment.
Dr Fiona Cornish
Cambridge
Sir, There are lessons to be learnt from the pandemic that will improve healthcare in the future. First, people have acknowledged that the NHS has limited resources. Fewer people are misusing GP and A&E access. Second, the move to telephone calls from GPs and hospital outpatient departments can only reduce costs, save time, increase access and reduce pollution, improving air quality, which will also improve health. There will obviously be times when appointments are necessary. Third, bureaucracy that has hitherto affected death certification has been reduced. This has enabled better use of GPs’ time, allowing them to prioritise treating patients.
Dr Anna Smith
Bampton, Oxfordshire
Sir, The Covid-19 crisis brings an opportunity for real positive change, to reward doctors, nurses and support workers and give British people the quality of health service that most other European countries enjoy. Funding for the NHS is severely limited by the principle of “free for everyone at point of service”, meaning it is entirely funded by the government, which simply cannot generate enough money to fund it properly. The investment by the Blair governments created unsustainable annual deficits. Austerity measures, which specifically excluded the NHS, led to big cuts in other public services. Most European public health services are hybrids. In France, anyone not earning gets free treatment. Those earning get some treatments free but contribute up to 30 per cent for others, which most cover through cheap monthly insurance. The time is right, politically, to say that those who can afford to pay a bit more should do so.
Paul Barnes
L’Horte, France
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