Margaret Thatcher’s onetime chancellor, Nigel Lawson, commented that the NHS is “the closest thing the English have to a religion”.
Certainly, as the UK census records a decline in adherence to Christianitycelebrating and lamenting the state of “our National Health Service“It brings together citizens of all creeds and political persuasions.
Everyone fears pain and disease. The aspiration of those who launched the NHS it was divorcing those real concerns from concerns about money and being able to pay for care.
The NHS would be paid for by tax, making all treatment “free at point of delivery”.
For many people, the idea that health care should not be paid for by the individual has become an article of faith.
This week, the inference that he had gone against this rule provided an effective line of attack against the prime minister, who is also a billionaire.
After days of challenges from the media and political opponents, Rishi Sunak finally confessed in PMQ that he had “used independent healthcare in the past”, while protesting “I am registered with an NHS GP”.
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What does ‘free’ really mean?
In reality, the divide between taxpayer-funded “free” health care and good private medicine is not as clear-cut as Mr Sunak‘s awkward moments would suggest.
Most NHS users actually make some form of personal ‘co-pay’ for services, each time they pick up a prescription.
According to the Office for National Statistics, at least 13% of adults paid for private healthcare in the last year.
And just to keep up with the current inadequate levels of treatment, the NHS itself relies heavily on recruiting workers and services from the private sector.
When the NHS was established in 1948, the official booklet sent to every home detailed its basic principles.
“Everyone, rich or poor, man, woman or child, can use it or any part of it,” he said.
“There are no charges, except for a few items. There are no insurance requirements. But it’s not a ‘charity.’ Everyone pays for it, mostly as taxpayers, and it will ease your financial worries in times of illness.” “
Early on, that “except for a few items” sidebar phrase revealed that not everything would be absolutely free.
Some services would require some payment by some patients.
Nye Bevan, the minister who launched the NHS, resigned from the Labor government when charges for “teeth and specs” – dental treatment, false teeth, glasses and surgical appliances – were introduced.
A few years later, a Conservative government introduced statute of limitations charges. All of this still applies today, even as the cost of healthcare to the nation has increased 10-fold.
The NHS budget in 1948 was £437 million, the equivalent of about £16 billion in today’s money.
The NHS budget for 2023-24 has been set at £160.4bn, subject to any subsequent emergency funding to deal with strikes and the “health crisis”.
From GPs to social care, the NHS setup is littered with anomalies
There are further anomalies in the way the NHS is set up: GPs are supposed to be the gateway to treatment in the NHS, but GPs were kept out of the system. His practices are small businesses for his own account, while in hospitals; doctors, nurses and technicians are employed by the NHS.
Technically, taxpayers do not pay directly to the NHS, but instead contribute to the “health and social services” budget.
But social care (caring for people who need it at home or in nursing homes) was excluded from the “free” principle and consequently underfunded.
With an increasing proportion of older people in the population, a lack of properly funded care has led to alleged “bed blockages” in hospitals and inadequate pay for care workers compared to those doing similar work in hospitals. the health service.
Attempts by various governments to find ways for families to contribute more to the cost of care have backfired. In 2017, Theresa May’s care proposals were quickly dubbed the “dementia tax.”. An earlier Labor plan was branded the “inheritance tax” by Tory finance spokesman George Osborne.
Meanwhile, more than seven million people are on waiting lists for treatment on the NHS.
Wait times are increasing in A&E departments and for ambulances taking patients to hospitals. Britain’s “excess deaths” are well above average.
Once again, the relationship between the SNS and private healthcare is seen by some as a solution and by others as a problem.
Some NHS hospital trusts are buying operations for their patients in private hospitals, or even French hospitals.
On the other hand, some trusts tell those on waiting lists that they can get their operations quickly if they go private, often using facilities in the same hospital, with the same NHS staff as second jobs.
Statistics suggest that the overall provision of NHS services was better during the early years of this century, after Tony Blair and Gordon Brown raised funding for the NHS to the European average for per capita spending on health care.
Since then, the UK has fallen behind again.
Using OECD data, the King’s Fund reported that, compared to most of the rest of the Western world, the UK has one of the lowest numbers of doctors, nurses and hospital beds for its population size.
Will the public pay more?
The debate continues as to whether it is a lack of funding or an inefficient bureaucratic organization that is responsible for the NHS crisis.
The public belief that health care should be “free” does not make it any easier. Opinion polls show public sympathy for calls for nurses, doctors and paramedics to pay and for paying more for the NHS.
But this generous spirit does not go very far in practice.
In a detailed survey by Redford and Wilton Strategies, asking “how much more in tax would the British public be willing to pay to provide more funding for the NHS”, 43% said they would pay nothing more and 24% set the additional maximum at £ 100. Only 11% said they would pay more than £500.
Does Labor have a serious solution?
Labor say the sprawling “NHS Plan” outlined by Sir Keir Starmer and Wes Streeting would pay for itself by ending non-dom status and without worrying most UK taxpayers.
This is very ambitious as the Labor Party proposes to end the staff shortage by doubling the number of places in the district medical and nursing schools; 10,000 additional nurses and midwives each year and 5,000 more health visitors.
It is also unclear how these long-term supply-side measures would “end the Tory crisis”, as Sir Keir puts it.
In its 75-year history, the NHS has been run by Labor and Conservative governments, and they have faced the same challenges.
It is true that in most years since the 2008 banking crisis, the NHS has been funded below the average 4% annual increase expected since the 1950s.
But at the time, funding levels were never a major point of difference between the parties.
Behind the rhetoric, the latest attempts to solve the NHS are from various parties.
The government has appointed Patricia Hewitt, former Secretary for Occupational Health, to conduct a review of the new integrated care boards. Both sides are developing long-term training programs to end staff shortages.
But the “free” NHS is so popular that politicians avoid questioning its basic tenets and organization, even though healthcare needs and available treatments are vastly different than they were in 1948.
Voters want more and more without having to pay more for it. Rather than confront patients or healthcare professionals with this dilemma, it’s easier to polish off old grievances and enjoy a shouting match over those, including Mr Sunak, who can pay for healthcare bypassing the NHS than others cannot pay.