The NHS keeps failing. Social insurance systems keep succeeding
No, this isn’t some attempt to “Americanise” the UK’s healthcare system. The US is the only developed country in the world not to offer universal access to healthcare, making it the weakest comparison for an NHS alternative. Nor is this some rogue or unpopular opinion.
It is what the statistics around waiting times and health outcomes have been telling us for ages, with another stark reminder delivered on Wednesday by the BBC.
Launching its new “NHS Tracker” – which allows patients to see how well or poorly their local health trust ranks on crucial targets, BBC News reported that “nationally England, Wales and Northern Ireland have not hit one of their three key targets for 18 months”. Not one. Scotland came out superior, having hit its A&E targets a show-stopping three times in the last 12 months.
This is failure.
Trying to list all the problems with the NHS requires far more than my column’s permitted word limit, so let us turn our attention to the cultural and political issues that prevent us from dealing with the systems perpetual failures.
The first port of call for NHS enthusiasts will be to blame each issue as it arises on a chronic lack of funding.
While spending on the NHS is real terms has continued to rise – and is estimated to keep ticking up over the coming years – it is the case that the rate of spending growth has slowed down compared to, say, a decade ago, while demand keeps increasing.
But money tends to be a secondary factor in determining the success of a healthcare system.
While countries like Switzerland and Germany spend a few percentage points more of their GDP on healthcare than the UK, many countries – including Hong Kong, South Korea, Portugal, Australia, and Iceland – spend close to the same or less, and fare better when it comes to patient outcomes.
It is clear that what sets the NHS apart from its European neighbours (and indeed, the rest of the developed world) is its extremely centralised system that allows for almost no competition or patient choice.
The UK’s unwillingness to adopt the social insurance systems that dominate Europe is what separates it on the league charts – usually ranking in the bottom third of international comparisons.
But these arguments are only useful when people are willing to acknowledge that the NHS is in crisis. Even in the wake of overwhelming evidence, many refuse to recognise its failures or criticise it in any capacity. The tribute paid to the healthcare system when it celebrated its sixty-ninth birthday back in July looked more like a collective effort to bury heads in the sand. The monotonous repetition that “the NHS is the envy of the world” isn’t anywhere close to the truth, and is particularly dubious in light of Wednesday’s findings.
Unfortunately, politicians across the spectrum have backed themselves into a corner on this topic. So much time and energy has been spent politicising the NHS, as well as praising it, that it is near impossible to have the necessary conversations now about what to do with its drooping status.
How long must the NHS keep spiralling downwards before serious action is taken? When it comes to healthcare, failure cannot be considered as an option.
This article was first published in City AM.
Recommended reading: ‘Universal healthcare without the NHS‘ by Kristian Niemietz