Choirs singing for NHS’s 75th birthday but may need a funeral cortege

It’s the 75th anniversary of the NHS on Wednesday but Newsnight, BBC2’s daily dose of Left-wing wackery and fashionable wokery, has already kicked off the celebrations with a characteristic tribute: a children’s choir singing ‘Happy Birthday NHS’.

It was cringe-worthy enough to have impressed the Dear Leader of North Korea, Kim Jong-un, who would no doubt have approved the state broadcaster’s creepy use of kids to parrot propaganda. I’m sure it will soon be on a loop on Pyongyang’s Channel One.

In truth, three-quarters of a century after the founding of the world’s first ever taxpayer-funded national health service, there is very little to celebrate. Yes, it has stayed true to its founding principles of healthcare free at the point of delivery and available to all regardless of financial means.

But most other advanced health systems embody these principles, too, and they do a much better job of delivering quality healthcare.

A new study of 19 major health services by the King’s Fund, a respected London think-tank which is hardly a knee-jerk critic of the NHS, found that our health service came second-last on the crucial yardstick of ‘saving lives’. Only America’s was worse.

Pictured is an NHS nurse with medication trolley inside a female ward at a London hospital in the 1950s

The NHS has among the worst survival rates for cancer, heart attacks and strokes among advanced health systems, which explains why Britain has the second-lowest life expectancy of rich countries (again, only America is worse). Indeed, life expectancy actually fell in the decade after 2010 while it increased elsewhere.

Yet NHS England still has the temerity to claim on its website that the NHS is the ‘envy of the world’. Perhaps it should be prosecuted under the Trade Descriptions Act.

There was a time when other European countries, still struggling to emerge from the ruins of World War II, looked enviously at the new system of universal healthcare we were building. But when they could eventually afford modern health systems of their own, none was foolish enough to copy us.

The NHS does score well in terms of general access because of its taxpayer-funded, free-at-the-point-of-use structure. But as the King’s Fund comes close to saying, this generally means good access to poor care.

It is fitting that Britain and America bring up the rear when it comes to international health outcomes because, in their own ways, they are the worst of health systems.

America’s private health insurance model is expensive, cumbersome and bureaucratic: it spends 17 per cent of its GDP on health — far more than any other country — and still manages to leave millions without proper health cover.

Britain’s is over-centralised, top-down, managerial, inefficient, in the grip of its own powerful vested interests and dependant on only one source of income: tax.

Today, nobody in their right mind would seek to emulate either the British or American systems of healthcare. But American healthcare has had a baleful effect on efforts to change the NHS.

Whenever British reformers suggest introducing some element of choice and competition into our system, decentralising resources and decisions or allowing new sources of funding to play their part, they are traduced as wanting to privatise the NHS, American-style.

The fact most European systems have nearly all these elements in their better-performing healthcare systems without ever embracing the U.S. model has escaped our politicians.

Mr Waterhouse, from Finchley, north London, who qualified as an emergency technician in 2021, records the conditions inside A&E departments across Watford and Barnet

Patients were seen lying on the floor in pain in the Aintree Hospital Accident and Emergency department

It has always struck me as ridiculous that even the most Europhile of UK politicians of the Left and Right would rather see off NHS reform by demonising American healthcare than learning anything from systems across the Channel.

Of course, the politicians are running scared of the public. They fear reform is political suicide.

Nigel Lawson’s quip that the NHS was the closest modern Britain had to a ‘national religion’ is no less true just because it is oft-quoted. The British hold the NHS in something of a mystical high regard, no matter how often it lets us down, an attitude unknown in any other country, even those with far better health services.

I kind of understand it. I grew up in the 1950s just as the NHS was finding its feet. I remember my working-class parents, who’d known the stress of getting ill and coping with medical bills they could not afford in pre-NHS days, grateful for this new healthcare system that took away that financial worry.

As a kid, the usual traumas of childhood — getting my tonsils out, breaking a leg falling off a hut, various vaccinations — were not financially crippling for a family of very modest means. This was true for ordinary families up and down the land. The NHS improved their quality of life. It made Britain a better place.

Such fondness, even admiration, has been passed down the generations. It is now fraying at the edges.

The current under-performance and inadequacies of the NHS mean that (according to last year’s extensive Social Attitudes Survey) less than 30 per cent are now satisfied with the NHS — the lowest rating since this polling was started — while more than 50 per cent were dissatisfied.

It’s hardly surprising. The NHS is struggling to cope on almost every front.

Paramedics were pictured being forced to treat paitents at the entrance to A&E at Aintree Hospital

Taken by an undercover emergency medical technician during the busiest days of winter, Channel 4’s eye-opening Dispatches documentary captures a series of damning incidents that staff warn have become commonplace 

There were 4.2 million people on NHS England waiting lists before the pandemic, which was bad enough. Now there are more than seven million, which means an incredible one in eight of England’s population is waiting for NHS treatment — and that’s set to rise this year and into 2024. More than three million have been waiting more than 18 weeks and 370,000 for over a year.

Other advanced health systems are astounded by these figures. All have problems of their own in post-pandemic times. But none has a backlog for treatment like the NHS.

That’s largely because, as we stood on the pavement and applauded the NHS during the pandemic, the NHS pretty much shut up shop for routine operations.

Of course, the pandemic took priority. But, more than any other comparable health system, the NHS stopped providing other services. Hip and knee replacements plummeted 46 per cent and 68 per cent respectively between 2019 and 2020. In Finland they fell 4 per cent and 3 per cent. Our cataract operations were down 47 per cent; in Germany 3 per cent.

From Germany to Singapore, advanced health systems quickly got back to normal post-pandemic. The NHS still struggles more than any to catch up.

In May more than half a million waited for more than four hours to been seen in A&E. Over 2.5 million are out of work on long-term sickness, many waiting for ages for NHS treatment or procedures, denying the economy workers it needs at a time of acute labour shortages.

Perhaps most scandalous of all, this is no country in which to contract cancer. Some wait months for a diagnosis — last April 22,500 had waited upwards of two months. Record numbers then wait weeks for their first treatment. The anxiety and toll on mental health is immense.

Those of us with family experience of cancer — which probably means most families at some stage — know that delays in diagnosis or treatment can sometimes mean the difference between surviving or dying. Cancer has become a death sentence in Britain in cases which, in other countries, would have been treated in time to prolong life.

There was a time when the ills of the NHS could be blamed on under-funding. No longer. Even during the so-called decade of austerity, NHS funding increased by 20 per cent in real terms between 2009 and 2019.

We used to spend less as a share of GDP on health than other major economies. Now we spend 12 per cent of GDP on health versus an average of 11 per cent in other rich countries.

Long queues of ambulances could be seen outside Aintree Hospital, with patients being treated in the back of vehicles

A Hull mum spent two nights sleeping on chairs at Hull Royal Infirmary and felt she was left with no choice but to head home after witnessing first-hand the immense pressure on the NHS

A long queue of patients line a corridor at Aintree Hospital as hospitals run out of beds to treat them

The £180 billion a year we now spend on health and social care gobbles up 40p of every pound we spend on public services. Only four African countries have bigger GDPs than the NHS has as an annual budget.

Yes, the number of acute and general hospital beds has declined and is now low by European standards.

But that started under the last Labour government and continued under the Tories because it was the consensus of healthcare professionals that we had too many hospital beds, backed by the panjandrums of the World Health Organisation. Perhaps they were wrong.

But in typical British fashion we have sacrificed capital investment in health facilities to pay for current spending. As a result, we have four times fewer CT and MRI scanners than Germany. In the digital age, the NHS is a digital joke. Even patients’ records are not properly computerised, despite billions spent on various IT projects.

When the NHS works it is still capable of providing world-class care. Many, many of its patients can testify to that. Amazing nurses, skilled doctors, well-run hospitals and state-of-the-art technology, especially in the big teaching hospitals. But too often it is none of that.

For too many the NHS means interminable waits, thousands of unnecessary deaths, endless strikes, surly staff, incompetent management, and yesterday’s treatment and technology.

The NHS will always need more money — in the next 25 years the number aged over 85 will double, adding hugely to healthcare costs — but if extra funds are not simply to disappear down an NHS black hole (as in the past), then extra cash needs to be coupled with major reforms.

But reform, sadly, is not on anybody’s agenda. The Tories now have a Corbynista approach to health: bung the NHS as much dosh as they can possibly scrape together and demand next to nothing in return.

One source explained how people were ‘lying on the floor in pain’ at Aintree Hospital

Footage shows corridors jampacked with patients

Less than two years ago Rishi Sunak, as Chancellor, came up with an extra £13 billion, ring-fenced for Covid catch-up. It simply vanished into the NHS black hole. The promise to get waiting lists below six million by 2025 was abandoned as soon as the money was banked; the pledge to speed up cancer diagnosis forgotten or ignored.

The Tories were at it again yesterday with vainglorious talk of the ‘most radical reform of the NHS ever’. It amounted to no more than £2.4 billion over five years for 15,000 extra medical school places by 2031, which in turn would produce 24,000 more nurses and 60,000 more doctors in a decade or so.

There was even talk of 137,000 more nurses by 2037 and of NHS England, currently employing 1.4 million, employing 2.2 million within 15 years. It’s a nonsense.

The idea the Tories know the NHS’s manpower requirements in a decade and a half, when they barely know what they’ll be next year, merely illustrates how they’ve bought into socialist manpower planning and support an NHS which doesn’t change in structure or operation but just grows like Topsy, making it even more unmanageable, unreformable and unresponsive to patient needs.

Labour, prodded by its impressive Blairite Shadow Health Secretary Wes Streeting, seems more reform-minded than the Tories (‘The NHS is a service not a shrine’, he rightly says). But it has few concrete proposals, much less a blueprint for change. I fear Labour will also scuttle back to the status quo at the first sound of gunfire from the NHS’s multitude of anti-reform battalions.

But, one day, there will have to be reform if the NHS is not to slide into irreversible disrepair. It is too soon to discern the details of that reform but it is possible to see its broad shape, for we know what works and what doesn’t. The American private insurance model doesn’t work. The British tax-funded monolith model doesn’t work.

What does work, as we can see from Germany to France, Switzerland to Sweden, is healthcare that is generously funded from the public purse but allows for a fair degree of private provision (which the state can pay for everybody to use) and private spending by people to supplement state spending.

I am realistic enough to understand that the chances of going over to a continental-style social insurance health system are close to zero, despite their better-than-NHS outcomes.

But I also believe that without a more flexible, mixed system of public-private provision the NHS is destined to continue to decline. In that event, come its 100th anniversary, Newsnight won’t need another choir. Just a funeral cortege.