Separation of NHS and State?

The NHS is far from perfect and a single-payer healthcare system is not the only model of universal healthcare that works. However, our love for the NHS reflects that of a state religion, preventing us from having the debate over structural reform that needs to be had.

UK Politics
Conrad Kunadu
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Protesters campaign against NHS cuts in London (Photo: Getty Images)

Beating the monarchy, the army and the Olympic Games, the NHS ranked first in institutions that make us proud to be British. 89% of adults support our national health system and even amidst growing dissatisfaction only a minority would actually support a change to the funding basis for the NHS.

But why?

Is it because we have a system that guarantees universal healthcare? Well seeing as at least 58 other countries also guarantee universal healthcare, this does not make us special. Is it because we are by far the best? Well, according to whom? Certainly not according to the Euro Health Consumer Index (which places us 14th); the OECD (placing us 20th); the World Health Organisation (placing us 18th); a report in the medical journal The Lancet (placing us 30th); the Legatum Institute (placing us 20th) and almost every study published on healthcare.

58 countries, not just the UK, offer universal healthcare (Source: Wikipedia Commons)

There is one exception however; the Commonwealth Fund’s report consistently places us first. However this report measures administrative inputs: the actual running of hospitals, NHS bureaucracy and how treatment is conducted. When you are measuring how quickly patients can obtain information or the speed at which test results are acquired, of course a centralised, regulated, national healthcare system triumphs. However in the report’s one measure of actual health outcomes — how effective the NHS is at actually saving lives — the UK this year scored 10th out of 11 countries. Or — as put succinctly by The Guardian when the UK also won in 2014 but came 10th on outcomes — “ the only serious black mark against the NHS was its poor record on keeping people alive.”

In the aforementioned reports, countries that repeatedly dominate include Japan, Australia, Germany, Israel, Sweden and the Netherlands. Where in some cases such as Sweden, healthcare is mostly government funded, countries such as Australia, Israel and the Netherlands all make extensive use of private healthcare. Where the United Kingdom makes use of the so-called “Beveridge Model”, many successes are also seen with the social health insurance “Bismarck Model”.

In Germany — where hospitals and insurance are private — they are taxed and these taxes go towards a “risk structure compensation fund” where taxes are redistributed to insurance firms with greater risk patients. Where health insurance is mandatory but benefits exist for those who cannot afford a basic package, the government still funds 77% of healthcare yet according to the Euro Health Consumer Index, is Germany the 7th best system (in 2015) but it has the most restriction-free and consumer-oriented system in Europe, giving people a choice of care unparalleled in any other country.

The NHS, by contrast, offers very little choice. Of course many would object to the idea choice matters at all. Who cares where you got treated if you get treated effectively? This may be a valid criticism, but when were people given the chance to make up their mind? It is untrue that any sacrifice we do make for choice is because of our superior healthcare system, because our healthcare system is not inherently superior. We trust the NHS because it appears to work. But so do the systems in Israel, Germany, Australia, New Zealand and dozens of other countries, in many cases seemingly better. Our attachment to the NHS comes from a false principle, and there is no discussion of any alternatives for us to accurately make up our minds.

What we do know for sure about the NHS is that it is severely underfunded; failing to meet targets; struggling to cope with our ageing population and it is “at breaking point.” Yet amidst the roaring debate on the NHS, the discussion of a change of system is nonexistent. Surveys and opinion pieces will highlight choice as something that needs to be improved, yet to consider what Germany does right is blasphemous. Criticism also include the high cost of drugs, a problem not seen in New Zealand where the drug companies who can provide drugs at the lowest prices are given a supply monopoly over certain drugs, driving down prices. Yet to consider change is supposedly pandering to corporate interests.

Jeremy Hunt, Secretary of State for Health since 2012, has faced much criticism for the state of the NHS in recent years. (Photo: Neil Hall/PA)

Of course the system is not perfect, with New Zealand also suffering from drug shortages. However it is an idea worth debating. The roles the market can play in healthcare are numerous. Where in Germany the government does fund healthcare predominantly, hospitals and insurance firms are owned privately allowing for the level of choice seen. In Israel, four official health insurance firms exist as not-for-profits and citizens must sign up to one of them, however within these private options exist. The idea private healthcare exists in one form is ludicrous, and the idea privatisation must look like the US is laughable. However full privatisation, or further privatisation of any sort is not on the table. Options that could potentially see huge improvements to healthcare in the UK have been completely disregarded.

This is not to say that a social health insurance system will work better. Nor am I asserting that sweeping privatisation of the entire NHS would work in the UK. It is hard to have any idea because the debate is not being had in the first place. Nothing other than the NHS appears permitted. The NHS is sacred and here lies the problem. Fundamental change to the operation of healthcare in the UK could be exactly the medicine we need, yet we are vehemently attached to a system which may need change.

This article should have been a passionate proposal or condemnation of structural NHS change, or at least a detailed analysis of our options. But the expert analysis is lacking. There is a chance that every proposition mentioned so far would not work. However there is also a chance the very fix the NHS needs lies in total overhaul. But as long as the NHS appears to be our state religion and we refuse to have this conversation, we will never know. Healthcare is literally a matter of life and death — if losing our beloved NHS saves innumerable lives then it is worth it. For the sake of all those who continue to perish due to NHS failures, we need to at least consider alternatives.