Finally someone said it, even if it was with caveats. “I’m not going to pretend that the NHS is currently the envy of the world,” Shadow Health Secretary Wes Streeting said at an event hosted by Policy Exchange yesterday. He went further, choosing his words carefully: “The NHS is in an existential crisis… It is failing patients every day.” Listen Listen.
We have reached the point in the electoral cycle where Opposition officials can smell power and are willing, if not to sacrifice themselves, then at least to wave a stick at some of their sacred cows. The government was wrong to offer more cash to the NHS without insisting on reform, Mr. Streeting said, correctly. He even admitted that in discussions about the future of the NHS, it is generally, the interests of your staff come firstweather “[the] the patient’s voice is often the lowest voice in the room. Exhibit A: the nurses’ strike. Again we are talking about the interests of the producers, not the patients they serve.
The problem with the NHS, however, is not just that its demands for funding are outpacing the economy’s capacity to meet them. It is systemically flawed. This week the Institute for Fiscal Studies published analysis showing the NHS has more staff per patient than ever before, and yet the number of patients it is actually treating has actually fallen. It is as if government incompetence, the pandemic and NHS structures have all conspired to produce the opposite of a magical money tree: a magical disappearing box, where money goes in and out.
The strange thing is that the more you look at the overall situation in the NHS, the more inexplicable its performance becomes. We are told that there are widespread staff shortages and more unfilled vacancies than ever before, and indeed that seems to be the case. However, the IFS data also shows that the NHS has been on a recruitment binge that has seen the number of full-time equivalent nurses, doctors and consultants rise by more than 8 per cent in three years. We are told that the demand is skyrocketing even faster than the supply, yet the cohort of “missing patients”, who simply suffered in silence during the pandemic, have yet to return and are seeking treatment. We are told that we have very few hospital beds per patient, yet when the government dramatically expanded the supply of beds by building the Nightingale Hospitals, we were told that the limiting factor was not beds but staff.
Most bafflingly, we are constantly being told that the entire system is chronically underfunded, but if you compare UK state spending on healthcare in 2019 with 18 other advanced economies, as the King’s Fund has done, we have an average of 10.2 percent. GDP. Excluding the US, which has sky-high spending due to its crazy and inefficient incentive structures, the UK’s spending is slightly higher than average, with Denmark, Australia, Ireland, Italy, Spain and Finland spending less than its GDP in health. Even on a per capita basis, according to OECD data, UK spending is right in the middle of the pack compared to a group that includes G7 countries, Scandinavia and Western Europe.
Despite this, British death rates from preventable causes are worse than in most of these countries and the pandemic appears to have hit the NHS hardest. An EU-OECD report shows that a third of chronically ill British retirees did not receive care during the pandemic, compared with a fifth in France and a tenth in Germany. UK surgeries for several major types of cancer fell to twice the rates seen in the EU and the number of cataract operations and hip and knee replacements plummeted at several times the rate seen in other countries in the UK. northern and western Europe.
The NHS, in other words, provides less care with more staff, and yet the workforce is still not happy. The nurses are on strike and are supposedly leaving en masse for an easier life as Amazon workers. Young doctors, whose number has risen 15% since 2019, are likely to do the same unless they get a 26% pay raise. They all cite stress, high turnover, and claims that hospitals are “not safe.” What’s going on?
How can this be true at the same time that we spend as much as any advanced country on health care and at the same time our hospitals are vastly under-equipped and our staff are so underpaid that they keep emigrating to Australia? Where does the money go? Are there bottlenecks that break the whole system, like the drop in the number of GPs or our dire shortage of capital equipment (MRI machines, mammograms, etc.)? If there are, why can’t they be urgently identified and addressed? Like a fascinating but terminal patient, the NHS has consultants, pundits and politicians crawling all over the place, but none of them seem able to tell us why it went wrong.
Here’s one thing we do know. The NHS model is not working. He is never able to plan ahead. It does not invest. You cannot retain staff. There is no point in putting more and more money into this system without first understanding how to put it to good use. If the rising costs of health care are simply a corollary of the aging and disease of our population, then improvements in efficiency and innovation are essential. The system we have does not encourage these improvements.
And this is where we run into the limitations of Mr Streeting and the Labor Party’s appetite for reform. A system ideologically attached to one size fits all, in which contributory payments and gradations of care are prohibited, is one in which patients will always be supplicants. A few dedicated employees could go the extra mile to serve these sick supplicants out of the goodness of their hearts. There could even be wards or clinics where this is the predominant culture. But the system as a whole will never reinvent itself or take risks to increase capacity and better serve patients because such improvements are not rewarded. It is set up to treat patients as expendable tokens that can be attached and removed at will, rather than finding increasingly convenient, personalized, and effective ways to treat them.
The result is not “equality”, as Labor imagines, but a brittle institution that operates by rationing and lottery. Its top planners are immune to feedback and have little reason to prevent trouble, because when the next crisis hits, it inevitably leads to another big government check.
Mr Streeting ludicrously claims that the NHS is “Britain’s greatest achievement”. This, like all other similar statements issued by politicians, is a neurosis that has nothing to do with reality or effective reform. Patients don’t care if the NHS is a source of national pride or a fancy logo for a T-shirt or a strange centerpiece for an olympic ceremony. They just want you to provide medical treatment quickly and effectively. As to why it isn’t, we’re still waiting for a convincing diagnosis.