The NHS is in crisis. We hear it everywhere: on the news, across family dinner tables, in workplaces and coffee shops, in GP surgeries and hospital wards.
It was the main topic of discussion at First Minister’s Questions, where John Swinney was lambasted over a Royal College of Nursing (RCN) report revealing the dire state of care in the NHS.
Sixty-seven per cent said they had been forced to treat patients in an ‘inappropriate setting’ and 91 per cent said this had involved patient care and safety being compromised.
The report contains horror stories of patients languishing on trollies for 24 hours, women miscarrying in corridors, and one cancer patient left outside a toilet because there was no bed for her.
The First Minister blamed the pressures of winter flu, and while that has doubtless contributed to the strain, a more honest answer would have admitted that, even if Scotland had been blessed by the most temperate winter in living memory, the NHS would still be struggling to manage.
Closing in on 18 years of the SNP in charge of Scotland’s NHS, and the service is on life support.
Collapse
Although once unthinkable, it is now entirely possible that the NHS could collapse. That scenario does not apply only to Scotland. The RCN report covered the whole UK and the picture is not pretty in any part of the country.
Wes Streeting, Keir Starmer’s vaguely impressive health secretary, has promised to ‘consign corridor care to history, where it belongs’, but when even cancer patients are spending their final days dumped outside lavatories – the woman mentioned above later died – the scale of improvement required seems not only daunting but insurmountable.
So, yes, the NHS is in crisis, but I struggle to think of a point in my lifetime when it wasn’t. It is a permanent crisis, with no resolution in sight and likely none possible.
The British tend to blame familiar culprits: insufficient staff, low pay, a surfeit of managers and bureaucracy. There are routine calls to bring back matron, or reintroduce prescription charges in Scotland, or some other tweak.
Spend more money? Annual UK-wide health spending was £16billion in 1955 but by 2023 it was £222.5billion. Britain shells out more on health as a percentage of GDP than Belgium, Sweden, Denmark, Finland or New Zealand.
Hire more doctors? There were fewer than 12,000 doctors in England and Wales in 1949. Now, there are more than 140,000 in England alone. Charge for prescriptions? Even if every prescription and related service in Scotland was charged for, it would raise £1.6billion. That sounds like a lot of money but it’s equivalent to just 7 per cent of the annual health and social care spend and less than the year-on-year increase being proposed in the current Budget.
What we have yet to confront, but will have to sooner or later, is that all the tweaks in the world will not save the NHS because the NHS cannot be saved. It is not a system experiencing dysfunction, it is a dysfunctional system.
What has done for the NHS is an ageing population, the prevalence of life-limiting diseases, and advancements in medicine. Britain is living longer. When the NHS was founded in 1948, the average life expectancy was 66 for men and 70 for women. Today, it is 79 and 83. Longer life is a blessing, but it comes at a heavy financial cost.
The most serious health challenges have changed. Back then, cancer accounted for 17 per cent of all deaths. Now, it’s 28 per cent. That brings bigger bills for life-saving treatments.
Medical progress has given doctors many more treatment options, but these have a hefty price tag.
In 1949, the NHS prescribed 225million items across the UK. Last year, it dispensed 1.45billion. The most commonly issued drug is atorvastatin, a heart disease drug, and the most expensive medicine is beclometasone dipropionate, used to treat asthma and chronic obstructive pulmonary disease. Last year it cost £320million.
Demand is growing, costs are rising, and investment is mostly limited to state spending, which must compete with other Budget priorities. This situation is plainly unsustainable, but no one wants to say so.
Across the UK, the NHS commands church-like devotion. Its clinicians are spoken of in reverent tones, as saints with stethoscopes, and devotees perform all manner of strange rituals of thanksgiving, such as applauding nurses from their doorsteps during the pandemic.
No matter how many pay increases ministers agree to, no amount of tithing is ever enough for worshippers who believe more money will produce miracles. To criticise the institution or its performance is blasphemy and to point out that other systems produce better results is akin to heresy.
Apostasy is discouraged with fire-and-brimstone sermons about the torments that await those who convert to a different funding model, the only alternative being the US healthcare market, where defibrillators come with a credit card slot and the poor and infirm are tossed into the street to die. Thou shalt have no other gods before the NHS.
And just as the religious cannot contemplate a world without redemption, adherents of the NHS are afraid of confronting illness without access to treatment. That is what lies at the heart of the British affinity for the health service: fear. We do not love the NHS, we fear the alternative.
Worship
The ardour of this allegiance would make more sense if the object of our worship was a world-leading system, rather than custodian of the second-highest avoidable mortality rate in high-income OECD countries.
A 2019 study found Britain had the worst survival rates for breast and colon cancer and among the worst survival rates following heart attacks and strokes.
Prevalence of obesity is nine percentage points higher than the OECD and European Union averages. Only 22 per cent of British GPs believe the current system works well, compared with one-third of primary physicians in similar nations.
With a record like that, the British public’s dedication to the NHS looks less like religion and more like a suicide cult. When a system intended to save and extend lives delivers higher mortality rates than its competitors, you either have to resign yourself to those outcomes or change the system.
I say change the system. I would look to European nations, which we are forever being told do things so much better than us, and learn from their health insurance set-ups to design a new healthcare model for the UK.
One in which everyone is guaranteed coverage regardless of income or pre-existing conditions; in which the state is purchaser of healthcare, rather than provider; in which market forces and competition are allowed to improve services and change outcomes; and in which those who can afford it pay costs towards non-emergency services such as GP appointments and minor out-patient procedures.
The NHS is not a religion. It is a bureaucracy, one that is no longer fit for purpose and should not be kept going out of fear or sentimentality.
It ought to be replaced by a universal healthcare system that actually works and provides patients with speedy, high-quality treatment. If saying so is heresy, I am happy to be a heretic.