The Beatles once released a song called ‘Help!’. This is a song that could be the theme tune of the British National Health Service. Once the proudest creations of this country after the Second World War, now is a pale form of its former self. The brain-child of Aneurin Bevan, antidote to the chronic health problems all over the country, ‘our NHS’ has been something of a millstone round the neck of the country that has to find new ways of funding it more whilst simultaneously trying to make it work for people and achieving positive healthcare outcomes that fully justify the vast amounts spent on it. An election issue that maintains itself throughout the years, the General Election 2024 sees healthcare and the NHS in second position, sometimes joint second with the issue of immigration this time around.
Public healthcare has been something close to a religion, according to the former Chancellor under Thatcher Nigel Lawson. There seems to be a general consensus up and down the country that the NHS is something that only needs more money to achieve better results. Spending on healthcare is around 12% of GDP and the NHS is one of the biggest employers in the world. Yet waiting lists are around 7 million, the NHS was squeezed and turned into the COVID service a few years ago, and whilst it boasts some incredible people working in it from top to bottom, almost half of the employees are not clinically trained nor patient-facing and it is now difficult to get a GP appointment in many parts of the country especially in London, and the growth of online consultations has left people feeling disconnected (pardon the pun) from the health service. The state of health is not healthy as public discontent has risen so much that both the Tories and Labour are seriously talking about reforming the NHS in some way, though at the moment in this campaign details about what this means remain very vague and remain impossible to see as a solution. The Tories have committed to opening over 100 new GP surgeries, Labour have promised better pay to deal with the long-running Junior Doctors strike. The nurses strike that occurred last year seems to be in the rear view mirror but how permanent this is remains to be seen.
The NHS is in a state of practical and ideological crisis. The NHS, practically, is immensely large. There has been a cosy consensus that what the NHS needs is more managers to make sure money is spent properly, efficiently and well. All that this has really done is force money out of the patient-facing sector and into middle-management which has become expensive itself. The answer to this problem was then to simply put more money in to the NHS in a bid to share the money round well with the help of the expensive management but this has not seen results. This is reminiscent of the old story about a woman who accidentally swallowed a fly, so she swallowed a cat to catch the fly, then swallowed a dog to catch the cat and then swallowed a horse to catch the dog. The lesson of this is that the solution can sometimes be worse than the problem and this seems to be the case. Coupled with the big issue of procurement (the cost of drugs the NHS has to pay for) where the NHS is being horrendously ripped off (mostly because it is easy to rip off a business that is backed by the tax payer), the state of healthcare is only getting more expensive. We are paying more than ever before on healthcare. So why is it getting worse?
The answer could lie in the ideological problem. Putting the issue of the NHS being a leading socialist hangover of the 20th century that still remains in this country aside, the NHS was envisioned by the father of the welfare state; William Beveridge, and even Aneurin Bevan, the man who designed the NHS, as a CURATIVE service, not a PREVENTATIVE service. The NHS was designed to cure people of illnesses, not prevent them. The only person who can prevent an illness is a patient; live a healthy life! Yet the NHS has morphed into a service that must cure, prevent, correct and be a safety net for all. This is simply impossible. If healthcare becomes a right rather than a privilege then living healthy no longer becomes a responsibility of the individual, as the negative effect from living unhealthy becomes a responsibility of the state. Coupled with the growth of a new understanding of illnesses (uncovering new diseases, mental health and new illnesses as a result of us living longer), the NHS has had to satisfy demands far outside its original intention. Bevan himself was booted out as Health Secretary when he began trying to correct the NHS by wanting to bring in prescription charges that were eventually brought in anyway! The NHS has become a promise that has been far too stretched, and is being destroyed by the demands of the public it has dutifully promised to serve. Like a lifeboat being sunk by the weight of hundreds of people trying to clamber aboard, it is in the crisis mode that seems impossible to solve.
This has been made all the more worse by the issue that we have an exploding population. The population of this country has increased by 10 million since Tony Blair came to power, 95% of this down to immigration. When the NHS was created the population was around 40-50 million. We are now north of 75 million. The NHS simply cannot sustain the health of an increasing amount of people. Though the argument is often laid that a decent amount of these new people eventually do work in the NHS the ratio is far too small to consider the NHS being sustained by a population increase, rather it is over-encumbered. Waiting lists of over 7 million, there is no real optimism for an NHS that has simply too few beds, too few hospitals, too few doctors, too little that could realistically be done and no one really knows how to fundamentally solve it from the two main parties. The NHS is really difficult to get behind and we all pay for it through taxation, muddying the claim that we have ‘free healthcare’.
We look across the pond and France has a greater quality of health provision at a far smaller cost to the tax payer. All over the world healthcare provision is improving arguably. This is because most countries have a dual policy; free healthcare for those who cannot afford to pay, paid healthcare for those who have the ability to pay. Of course, looking over in America there is a big fear that the introduction of an insurance-based healthcare service will see the spiralling of premiums but ultimately the hybrid-healthcare-market version is seeing better results, which could break the ideological love of the purist public healthcare in this country. We might see things change and indeed the mood in the country is finally seeing a change in the wind that has only ever blown in one direction since 1948. Germany, Spain, France, many countries with similar populations, similar demands and similar expectations see far more satisfaction. Maybe we can learn a thing or two from them rather than in the long-prevailing British/Socialist exceptionalism that we are ‘doing things better’. We simply aren’t.
Whether the two main parties can actually do anything as they are ideologically wedded to the status quo of healthcare remains to be seen. There is not much optimism here. In poll after poll so far the voters see the Labour Party as more competent on healthcare but this is largely because of the lack of innovation and success from the Tories and long-standing running of public health from the now-chancellor Jeremy Hunt. It is a worrying state of affairs and the word crisis is now such an old word it seems to have rather lost its meaning when it comes to healthcare and the United Kingdom. Voters will be very keen to see an actual slice of innovation in this election and it could be a big vote winner. Could the answer come from other parties? We will see.
For now we deal with our healthcare now much more in a way that it was meant to be before; because public healthcare is doing so badly more people are living healthier lives so they don’t get sucked into the awful maelstrom of the NHS care in some areas of the UK. Perhaps this is the answer. A study many years ago found that if people exercised 3 times a week minimum then spending on healthcare would halve overnight. Perhaps the answer is for us voters to look at ourselves and prevent ourselves from becoming a healthcare burden on the state. But who knows. It certainly wouldn’t be popular to say on television during a debate…could it?
This article first appeared on the TDL Times. For more information, articles and more please visit www.thetdltimes.com.
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