(Photo by Anthony Devlin/Getty Images)
Artillery Row

Who do we think we’re kidding with the NHS?

Someone somewhere damaged this country very badly

My local GP surgery has a little scam that I am told is widely used across the country. When you phone up for a doctor’s appointment, the receptionist pretends that they are fully booked for the next three or four weeks. This is your cue to explain that you are in some pain and really need to be seen sooner than that. The receptionist then explains, slightly conspiratorially, that if you give them a call at 8 am tomorrow, they might be able to squeeze you in.

The NHS lies to us and we lie to ourselves about the NHS. That’s the deal

The next morning, you call at 8 o’clock sharp, but the phone is engaged because everybody else has been told to do the same thing. You hang up and try again. Still engaged. You try again. And then again and again, queuing with all the other mugs as if you’re trying to get tickets for the Glastonbury Festival. Finally, a receptionist answers and, lo and behold, an appointment is available today, albeit not with the person who is nominally your doctor. When would you like to come in?

I’m showing my age with the Glastonbury analogy. The festival switched to online booking twenty years, something that remains beyond the NHS. I am not sure why a system that involves lying to patients became best practice in our doctors’ surgeries – perhaps it weeds out time-wasters? – but it is a small sign that our health service is some distance from the cutting edge.

The NHS lies to us and we lie to ourselves about the NHS. That’s the deal. On Sunday – the NHS’s 72nd ‘birthday’ – Matt Hancock asserted that the NHS is ‘the best healthcare system in the world.’ Can he really believe this? Does anyone? It is debatable whether the NHS is the best healthcare system in Britain. Believing it to be the best in the world requires a uniquely insular form of blind patriotism.

It is a claim that can be tested with empirical evidence and there are plenty of health statistics to consult. The UK has 2.5 hospital beds for every thousand people. The OECD average is 4.7. We have 2.8 practising doctors for every thousand people, less than the OECD average of 3.5, and we have 7.8 nurses for every thousand people whereas the OCED average is 8.8.

We have far fewer CT scanners and MRI units than most OECD countries. Your chances of still being alive five years after being diagnosed with cancer are generally lower in Britain than in comparable countries. And whilst we tend to have shorter waiting times for some forms of surgery, such as hip and knee replacement, we trail countries such as Finland and New Zealand which spend less money on healthcare.

The UK is a healthcare laggard in so many respects. On many important criteria, it would be a huge improvement if it could lift itself up to the standards of Estonia or Chile, let alone Switzerland or Germany. It is, at best, average. The only table it tops, unless you include statin prescriptions, is access to healthcare, which is 100 per cent in the UK. But it is 100 per cent in the majority of OECD countries and is 99.9 per cent in several others. The NHS does not have a monopoly on universal healthcare. Other countries just do it better.

It is the no-questions-asked universalism of the NHS that makes it top dog in the Commonwealth Fund’s league table of healthcare systems. This study is the outlier that the likes of Owen Jones never shut up about. The Commonwealth Fund is a think tank dedicated to persuading Americans to adopt an NHS-style system and its criteria reflect this, being heavily weighted towards process and principles rather than results. Of the eleven countries in the study, the UK performs so well on ‘access’, ‘equity’ and ‘care process’ that it gets the top score overall, despite coming second to last on the non-trivial category of ‘health care outcomes’. In the timeless words of the Guardian when it reported the results in 2014: ‘The only serious black mark against the NHS was its poor record on keeping people alive.’

The traditional explanation for this minor shortcoming is the NHS’s ‘chronic underfunding’, but that excuse no longer stands up to rigorous examination. By the logic of its supporters, a state-owned health service should need less funding than other systems because there are no greedy businessmen scooping up profits, but leaving that socialist delusion aside, the NHS is simply not underfunded. It is difficult to keep up with the figures, so quickly do they rise, but in 2018 the state spent £167 billion on healthcare, more than double the amount spent in 1997 (in real terms) – and that was before the spending splurge announced by Theresa May for the NHS’s 70th ‘birthday’. Total healthcare spending in Britain has been above the OECD average for some time, both in per capita terms and as a proportion of GDP, and it is likely to be above the EU average when the figures for 2019 are published.

By no sane metric is the NHS the world’s best healthcare system. In most respects, it does not even reach the status of adequate. And yet in the shadow of the coronavirus, the prospect of meaningful reform has never been more distant. So many NHS flags are flying from public buildings that there is an unnervingly sense of living in occupied territory. The weekly round of applause for carers has morphed into an annual clapathon for the NHS as an institution. It has become a full-blown cult. The public will brook no criticism.

As the years roll on, it is possible that somebody might notice that the British are paying more than average for a below-average health service

At least the 70th anniversary involved a round number. The 72nd anniversary has no particular significance and yet this questionable milestone in the NHS’s history has been hailed by everyone from the Royal Navy to the Royal Mail. Network Rail and the Royal Family lit their buildings blue as a mark of respect. The Bishop of London raised a toast with her NHS branded tea cup. Woe betide any senior politician who didn’t stand on their doorstep clapping like a seal.

There was always something a bit North Korean about an organised moment of national applause, particularly at a time when leaving the house for most other reasons was illegal, but it was understandable that people wanted to show their appreciation for those who put their lives at risk treating COVID-19 patients. Clapping for carers made sense in the context of those dark days. Clapping for the NHS, however, makes about as much sense as clapping for the DVLA or dancing for the Student Loans Company.

Yes, the carers were putting their lives at risk – because the NHS had failed to equip them with PPE. It is the NHS’s fault that junior doctors have to work such dangerously long hours. It is the NHS’s fault that thousands of elderly people were shipped off to their death in Covid-riddled care homes. It is the NHS’s fault that thousands more will die this and every year from diseases that the average developed country is better able to treat.

Doctors and nurses on the frontline are overwhelmingly dedicated, competent and hard-working, but they are trapped in a failed system. Every attempt at reform has created more layers of stifling, money-burning bureaucracy. The NHS employs 1.2 million people and is so vast and complicated that no single individual fully understands it, let alone the average taxpayer. All the public wants to know is that more money is being pumped into it, and so that is all governments do.

As the years roll on, it is possible that somebody might notice that the British are paying more than average for a below-average health service, but it is more likely that new excuses and scapegoats will be found. The public are already being primed to blame themselves for the NHS’s failings. If only we weren’t so fat and lazy, goes the message, the system would work. This is the logical conclusion to the thinking – made explicit during lockdown – that it is the public’s duty to protect the NHS rather than the other way round.

In the meantime, we will continue to applaud the idea of the NHS, worshipping a caterpillar that, for some reason, never quite became a butterfly. We will continue to view basic healthcare as a miracle of this island race, as if being born in a hospital or having one’s life saved by medicine could only happen when the state owns the infrastructure. We will continue to accept waiting four hours for emergency treatment and six months for an operation as if it would be unreasonable to expect anything better. After all, it’s free!

To the rest of the world, Britain’s infatuation with its own healthcare system is a baffling eccentricity, like those Pacific Islanders who worship the Duke of Edinburgh. But we don’t care. When it comes to healthcare, we are used to ignoring the rest of the world (except the USA). The NHS makes self-described internationalists become peculiarly parochial and narrow-minded, almost jingoistic. Insofar as we give other countries’ health systems a thought, we assume that they have either copied the NHS (may peace be upon It) or have no healthcare at all.

Enjoying The Critic online? It's even better in print

Try five issues of Britain’s newest magazine for £10

Critic magazine cover