To fix the NHS, we must learn from our European neighbours

Jack M. McClure

July 27, 2018

It was almost impossible to miss the celebrations for the 70th anniversary of the NHS earlier this year. Created in 1948 by the post-war Attlee government, it was and still is a mammoth experiment on central planning in providing healthcare.

The service has undelivered in recent years, prompting Theresa May to pump an extra £394 million per week in real terms by 2023/24. Is this not the simple solution? After all, if we are to believe the mainstream narrative, the NHS has been chronically underfunded due to austerity measures. However, we must realise that this is a highly simplistic account of the weaknesses of the NHS.

The flaws are fundamental, stemming from its very foundations. The bureaucracy involved in running and maintaining the NHS often distracts doctors and staff from treating patients.

Fiona Bulmer, a non-executive director of a London hospital described her experience: “The hospital I was involved in had a problem with its A&E waiting times. We were provided with ‘help’ from multiple NHS intervention teams. There were so many of them that they arrived in a bus, convinced that everything could be solved by more targets and action plans. After several weeks of this, they came up with an action plan containing 147 individual actions, each of which then had to be measured and monitored and reported back to the intervention teams. We all knew that the action plan was there to tick the box required by the central bureaucracy, not to solve the problem.”

Looking at efficiency rankings and health outcomes measured by the OECD, the NHS usually ranks in the bottom third among wealthy, industrialised nations. Despite all of this, the UK spends a higher percentage of GDP on the NHS than the European and OECD averages. So pumping money into the existing system is clearly not a solution for long-term success, especially given that we have only just stopped running a day-to-day budget deficit.

And this ties into a separate issue: the political climate in the UK does not allow for criticism of the NHS – it instead has a quasi-sacred status. When MEP Daniel Hannan spoke on US news in the midst of the Obamacare debate and articulated that he wouldn’t “wish the NHS on anyone… We spend a lot of money and we get very bad results,” he was rebuked as “eccentric” by David Cameron.

Just this year, a researcher from the Institute for Economic Affairs, Kate Andrews, went on the BBC’s This Week to discuss healthcare reform with Labour MP Alan Johnson and Conservative MP Anna Soubry. The way they responded to the notion that the NHS needed reform was telling. When host Andrew Neil said survival rates for some cancers were worse in the UK than in Costa Rica and Brazil, Soubry responded by saying “And?”. When Andrews stated that “The principle of universal access has been adopted by everyone, but the centralised bureaucratic system has not and that’s why they have better patient outcomes… Can’t we just look at these systems to try to get some better healthcare in the UK?”. Johnson replied, “Why?”.

It seems like any critique of the NHS is politically unacceptable. This is to the detriment of everyone – patients, staff and the government. Criticism is the root of progress, and when you make the soil of discourse inhospitable, nothing will grow.

What I believe is embedded in the national psyche is the dichotomy between the socialised NHS and the “free-market” system in the United States, traditionally provided by monopolised insurance companies. The characterisation of this system as harsh and profit-driven, underlined by TV shows like Breaking Bad, in which a hardworking schoolteacher is not able to pay for cancer treatment without selling meth, is somewhat justified. As a result, any criticism of the NHS is often seen as an endorsement of the American system.

However, what we tend to overlook is that the NHS is just as extreme as the American system, just a socialist extreme. Many countries in Europea have social health insurance systems which utilise the benefits of the private sector and free-market innovation, but also provide universal access to those who wouldn’t be able to afford it themselves.

This is the norm in countries such as Germany, the Netherlands and Switzerland – countries that deliver the best results in terms of outcomes and offer greater choice to citizens. Although not perfect, they demonstrate how market-based systems can be more efficient and effective than the NHS. Indeed, research by the Institute of Economic Affairs shows that tens of thousands of Brits who die each year after suffering heart attacks, strokes or having different types of cancer, would not die if they were treated in some European countries.

Surely we can all agree that the NHS can learn from systems like these — after all, a social health insurance system represents the best of both worlds.

Because we are witnessing greater pressures than ever on the NHS, and simply pumping more money into it in its present state will not solve any of our problems –  indeed, it will simply kick the issue down the line for further generations to deal with. We need to start engaging in an open debate, and we need our politicians to start facing some hard truths. Otherwise, the Left’s ideological obsession with keeping the NHS owned and run by the state will lead to countless more unnecessary deaths. And that would be a tragic scandal.


Written by Jack M. McClure

Jack M. McClure is a student, and Editor of Barrister not Barista.


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