Like many readers, I owe my life to the NHS. I was born a few months prematurely at Watford General Hospital in 1999; I went back there a decade later with a ruptured appendix. In both cases, had it not been for the timely intervention of NHS doctors and nurses, I may not be writing these words today in time for the health service’s 75th birthday.
But wait. I don’t really need the word NHS in that sentence, do I? I owe my survival to the wonders of modern medical science and to the heirs of Hippocrates who practice it. That your employer is a state giant, compared to the public-private model found in most of the civilized world, is neither here nor there. It reflects our strange national relationship with the NHS which could hold it responsible, rather than the men and women within it.
Other countries do not dedicate sections of their Olympic opening ceremonies to celebrating their health systems. They didn’t spend their Thursday nights during Covid coming out to clap. They don’t claim it’s a world leader when multiple international rankings suggest it’s poor at keeping people alive, which is, fundamentally, its job, and when post-Covid waiting lists plunge toward eight million.
I hardly need to explain all of this to all of you. Those of us willing to openly pose as heretics to our national religion are no longer howling in the desert. We are no longer thriving on the occasional column by James Bartholemew or buoyed by a Kate Andrews time to ask appearance. Skepticism of the NHS is an increasingly common political phenomenon, with even Sajid Javid, the former Health Secretary, openly calling for large-scale reform.
However, the Bromsgrove MP is walking out of the House of Commons, freed to speak the hard truths that his career-minded colleagues cannot tell. It is therefore of the utmost importance that Wes Streeting, the Shadow Health Secretary, is equally clear that “vested interests and producer interests” will not stand in the way of “reforms that will deliver better results for patients” under the Labor Party.
Even Streeting’s kind criticism of a service that gave him less-than-stellar care during his own cancer scare has branded him, in his words, “something of a heretic” among his fellow worshipers at the altar of Aneurin Bevan. But he is among those on the left for whom he is perpetually the 27thhe July 2012 that most must take into account the changing mood among the NHS’s most important audience – the public.
With waiting lists increasing, an increasing number are voting with their feet and using private healthcare. Last year, there were more admissions for ‘self-pay’ treatment than ever before: 272,000, compared to 199,000 in 2019. In total, private hospitals had a record 820,000 inpatients and day care patients, as users they paid for procedures like cataract surgery, chemotherapy, and new hips.
Many conservatives would praise those who choose to go private at their expense for reducing the burden on the public system as a whole. After all, the concomitant new burden on the state sector has always been one of the easiest arguments to oppose closing private schools (apart from, you know, what it would mean for the First XI). But this increase in private treatments is not an altruistic move on the part of BUPA enthusiasts from the middle class and nobles.
Indeed, as John Burn-Murdoch has highlighted, while UK hospital treatment spending rose by 60 per cent overall between 2010 and 2020, it more than doubled among the bottom fifth of wage earners. In relative terms, the poorest now spend as much as the richest. The NHS failures are hurting exactly those Bevan hoped to help with a free point-of-use system.
Clearly, if increasing numbers of voters voluntarily opt out of the NHS, this has long-term implications for the sustainability of the taxpayer-funded monolith model. Voters will wonder why their taxes are at record levels if they still can’t get a basic operation. It is a fracture in the social democratic commitment that underpins our political system, whichever party is in power.
That is not to say that the public can now easily convert to the cause of replacing the NHS with whatever alternative country model is the flavor of the month in the expert world. As James Frayne has often written for us, voters are convinced that the NHS, and public services more generally, is riddled with waste and inefficiencies. But they will also naturally, and literally, cling to the nurse for fear of worse, raised as they are on a diet of emergencies horror stories.
A very conservative sentiment, that. It is true that the Tories have gone to great lengths to eat away at Labour’s self-image as the “NHS party” over the past decade. We had David Cameron’s three-letter top priority, Theresa May’s ’70she birthday gift of a lot of cash, and Boris Johnson’s Damascene conversion to taxpayer funding, all via a certain Vote Leave bus and Jeremy Hunt badge.
In the last election, Johnson and the Conservatives had become more trusted than Jeremy Corbyn and Labor with the health service. Had it not been for covid, this could have been a stepping stone to an eventual reform agenda in a second term for Johnson. However, lockdowns designed to protect the NHS have only helped contribute to its wider, creaky collapse.
The entire Western world is grappling with the problem of demographics, as ever larger and sicker populations are supported by ever fewer young and handsome taxpayers (hello!). Politicians have been talking about serious social care reform for much longer than they have contemplated its NHS equivalent. Despite Andrew Dilnot’s best efforts, the can keeps getting kicked down the road.
For all of Streeting’s warm words, he is proposing nothing more radical than nationalizing GPs, begging the Treasury for more money and introducing a workforce plan suspiciously similar to the government’s. Furthermore, Labor have made it clear that they take social care as a secondary issue. As with housing, the consensus is that something must be done, but no one is willing to suggest what.
The sad reality is that the NHS is celebrating its 75thhe anniversary with record funding levels, record waiting lists and record dissatisfaction. It remains a fiscal black hole struggling in its basic task of keeping the sick alive. Any birthday applause rings hollow, as do the words of any politician who is unwilling to admit that the emperor is naked and to tell the truth that enduring another 25 years of this appalling system would be utter folly.