The sooner we admit the NHS is broken, the sooner we can start to fix it

The centrepiece of the opening ceremony of the 2012 London Olympics was a celebration of the NHS.

This was understandable: our healthcare system is a uniquely British institution, after all.

But in this case, the word ‘unique’ says something deeply worrying.

For it is uniquely British only because no other country has ever sought to copy it.

The world was watching that Olympic opening ceremony, but no other country looked at those nurses and doctors dancing energetically around the beds of their smiling patients and concluded that this was an institution they wanted to introduce into their own countries.

Why not? And what does that say about the NHS?

Much of the public adoration of the NHS is founded on fading folklore memory of pre-1948 Britain, when millions suffered illness and early death because they could not afford to pay a doctor.

That obscenity cast a long shadow, but it’s time to consign such memories to the dustbin of history, along with child chimney sweeps and witch-burning.

Most other countries, after all, have very similar histories.

Britain was not unique in its suffering from appalling health inequalities in the past, or in its attempts to seek a better, fairer way of looking after the health needs of its post-war population.

Other nations faced the same challenges, and they arrived at different solutions.

But in Britain there can be no solutions other than the one that Nye Bevan, the firebrand Welsh MP who served as health secretary in the post-war Labour government, came up with three quarters of a century ago.

We may live in a world transformed, a globalised world of technologies undreamed of in the past century, a world of instant communication, algorithms and artificial intelligence, but when it comes to health policy, Nye’s word is the secular equivalent of holy writ set in stone.

And God help any blasphemers who doubts his word.

Only heretics dare suggest that maybe – just maybe – not everything the NHS does, and the way it does it, is perfect, that perhaps there are alternative ways of funding it, and that there might be lessons to be learned from the way other modern democracies provide healthcare for their own citizens.

Such is the current state of debate about what is arguably the most important public institution in the country.

The combined cost of health services in England and Scotland is nearly £200billion a year.

Yet still one in seven Scots languishes on waiting lists for treatment.

Cancer survival rates are lower than those in some EU countries and economists predict that the funding crisis is only going to get worse as our population ages.

Perhaps we should be addressing these issues in a full and frank public debate.

But every time politicians even raise the possibility of doing things differently, they are shouted down, accused of wishing to ‘privatise’ the NHS or – worse – introduce an American-style service that only the wealthy can afford, leaving the vast majority at the mercy of exploitative private companies.

And so the pantomime goes on, with our political parties too frightened to explain exactly how they will address the demographic time bomb that is looming.

There are only two politically acceptable ‘solutions’ to what now seems like a permanent NHS crisis: more funding – and even more funding.

Were our politicians slightly braver, more imaginative, were they less terrified of incurring a disapproving look from voters, they would be honest about the challenge we all face.

They would concede that a funding and organisational model brought into being a matter of months after the defeat of the Nazis, might not necessarily be the right model for healthcare in the third decade of the 21st century.

Could it be that criticism of the NHS, or any new thinking about alternative ways of funding healthcare, are shouted down because the arguments for maintaining the status quo are in fact too fragile to withstand robust scrutiny?

Why, when faced with criticism of the NHS, do its defenders seek falsely to claim that the only choice is between what we already have and the admittedly dreadful service that United States citizens must tolerate?

Why not admit that there are plenty of other health services in the world – systems that use a variety of funding mechanisms?

And that many of them have better health outcomes than here in the UK?

Are we seriously suggesting that Britain has nothing to learn from those other countries?

Britain comes nowhere near the top of league tables when international comparisons for cancer and cardiovascular survival rates are compiled.

We even come behind the United States in many metrics.

What is extraordinary, in a country whose society has been so drastically fractured by our public debate about Brexit, is that even the most enthusiastic Remainers, those who insist that the EU is better, more progressive, more caring, more tolerant than backwards-looking, old fashioned Britain, will draw the line at healthcare.

We should all be more European in every aspect of our lives… except when it comes to healthcare.

Germany, for example, has a healthcare system funded by a combination of public funds and private insurance, and its health outcomes, including life expectancy, put Britain to shame.

The country has a public health system, but it’s funded in a radically different way from the NHS.

Around 86 per cent of Germans are enrolled in schemes run by not-for-profit insurance organisations known as sickness funds. They choose which fund they sign up to.

These are paid for by deductions from wages with employee and employer contributions.

Some small out-of-pocket payments are required for hospital visits and medicines.

The German system is also better staffed than the UK, relative to the population. Analysis by the Nuffield Trust in 2019 concluded that the UK had around nine nurses per 1,000 people, while in Germany there were about 14.

The disparity in bed numbers was wider too, with Germany’s eight beds per 1,000 more than three times the UK figure.

The French healthcare system is funded by social security contributions, central government and partly by patients themselves, who have to pay a percentage of costs for medical treatment or prescription drugs.

But like the UK, France provides healthcare to every resident regardless of age, income or status. And life expectancy for French women is the second highest in the world.

The healthcare system in Italy, also provided through a mixed public-private system, is considered one of the finest in the world.

Meanwhile, a report by The King’s Fund earlier this year concluded that Britain’s life expectancy rates are among the lowest in Europe.

The dreaded 8am rush to get a GP appointment has become the bane of all our lives, as local surgeries struggle to cope with the aftermath of the Covid pandemic.

Every winter heralds a new crisis of hospital bed shortages.

And still the NHS is plagued by industrial action by nurses and junior doctors.

According to the Organisation for Economic Co-Operation and Development (OECD), the UK spends more on healthcare than comparable countries (about 11.3 per cent of GDP in 2022), but has fewer hospital beds and diagnostic tools, and pays nurses less.

Across the countries studied by the OECD in 2021, there were on average 4.3 hospital beds for every 1,000 in the population.

But in the UK the figure was only 2.4 beds for every 1,000, with only Mexico, Costa Rica, Columbia, Chile and Sweden reporting lower ratios.

So what, if anything, can be done to improve things?

The first course of action should be to make a decision not to rule anything out. And yet that’s exactly what our politicians have always done.

Even when solutions are staring them in the face, they will insist that if it’s never been part of the NHS before, then it shouldn’t be in the future either.

Even when other countries have successfully tried and tested those exact solutions.

We need to be wiser about how to spend scarce resources.

Every now and then, a brave politician will tentatively suggest that patients should pay a small sum towards their GP appointments, or even be fined for failing to keep an appointment.

But they are soon shouted down and told to behave themselves on pain of deselection or electoral defeat.

In Scotland, the introduction of free prescriptions for all was a major boost to the incomes of those already wealthy enough to pay for medicines.

But woe betide any political party that might seek to reverse this redistribution of wealth from the poor to the rich.

Switching to a European-style social health insurance system would be no panacea – what works in one country could not be expected to work in precisely the same way elsewhere.

But what does it say about the state of political debate in our country that such a reform is immediately dismissed as beyond the pale?

Germany, France and Italy are hardly basket cases or third world countries.

Until two years ago they were among our most important EU partners.

The question for policy-makers should not be how best to preserve the NHS as it is but rather how can patients’ interests be prioritised?

The NHS was created to serve the country, not the other way around. It is not there to provide employment for its million-plus workforce. It is not there to create jobs for an army of administrators and bean counters.

And it certainly doesn’t exist to provide well-paid work for diversity, equity and inclusion officers, whose numbers have exploded in recent years with no measurable improvement in the quality of care given to patients as a result.

It exists for us, the UK citizens who pay for it with our taxes.

That is its primary, if not its sole, function.

And as the funders of the NHS, we should be insisting that it is no longer run in the shadow of a past that is viewed through rose-tinted glasses.

We should demand that it becomes a modern, flexible, dynamic and innovative service.

We could start by shattering a central shibboleth of faith in the NHS: that privatisation is somehow alien to it, with its only aim to make profits from vulnerable patients.

In fact, the private sector is an essential mechanism for providing essential health services.

Opticians and dentists, for example, earn much of their income from privately paying patients.

And no one seriously supports the idea of a future government nationalising Specsavers.

Even local GP practices, our primary interface with the health service, are essentially private companies contracted to provide services to the NHS.

No one in this country gets through life without dealing, at one point or another, with a private provider of healthcare services.

Institutional and financial reforms are necessary and inevitable at some point.

But we as ordinary citizens must share some of the responsibility for helping improve the nation’s health.

Far too often we have allowed politicians to convince us that our poor health – whether from being overweight, drinking too much alcohol, not taking enough exercise or smoking – is not our responsibility but is the fault, somehow, of the Government, or the food industry, or advertisers.

We are told to believe that we are powerless, susceptible to the diktats of these external forces.

We eat too much because planning laws allow too many fast food restaurants to be built.

We eat fatty, processed foods because we were never taught to cook at school.

We smoke because we’re influenced by Hollywood stars doing the same on screen.

It’s all a big, dangerous lie. We choose what to eat and what lifestyles to pursue.

If we rely on the Government to tell us how to live and to intervene to force us to make better choices, we surrender all responsibility for our own lives and our own health.

It’s a lethal combination. We rely on the Government to govern how we live and what we eat, and then demand that the health service we pay for through our taxes delivers better results, even as we rule out any kind of radical reform that might improve that healthcare system.

If politicians really meant what they say about the importance of their constituents’ health, they would join together to ensure that the NHS was no longer a political football.

They would lay aside their instincts to make political advantage out of this debate and accept that maybe, just maybe, all those countries with different health systems might have something to teach us after all.