Why We’re Losing Faith in the ‘Church’ of the NHS

A comprehensive British Social Attitudes survey published in March revealed that overall satisfaction with the health service has fallen to 29%. Across all parties, ages and income groups, more than half of the respondents were dissatisfied with its performance. That’s hardly surprising. Waiting lists for treatment have topped the seven-million mark since the pandemic. NHS doctors are threatening to continue their current round of strikes, already into their eighth month, until 2025. The nurses’ union has only just settled its dispute. The ambulance drivers are back to work, although another “winter crisis” will surely see them waiting with patients outside hospitals until a bed becomes free on the wards.

Meanwhile, self-pay admissions to private healthcare are soaring. Private hospitals admitted more than 820,000 patients for treatment last year. Why wait up to a year for cataract surgery or a hip replacement when you can pay your way and get it done sooner? The lowest-earning fifth of the population, according to the Office of National Statistics, now spends as much on private health as the richest in relative terms. 

Some of my own gloom stems from having seen the NHS at its worst. During the pandemic, my brother rang a general practitioner to ask him to call on our unwell 95-year-old mother. The doctor failed to show. After she collapsed, she was taken to the local hospital in an affluent London neighborhood and belatedly diagnosed with pneumonia. Despite being of sound mind, my mother was placed in an Alzheimer’s ward because of bed shortages. Her last hours of life were disturbed by patients who cried out at their unfamiliar surroundings. 

Of course, the pandemic overloaded many healthcare systems. But my mother’s treatment illustrates some of the NHS’s greatest deficiencies. The British health system has one of the lowest ratios of beds to population in the developed world. It also spends too little on the primary care required to keep patients out of the hospital through early diagnosis and preventive treatments. Staff shortages are alarming.

Yet the NHS principle of health treatment that is “universal and free at the point of care,” funded by taxation, is still highly attractive to most voters. And perhaps the public isn’t wrong. The cost and disruption of switching to another funding regime seems hardly worth it — although top-ups for extra services might inject more capital into the system. Every other bureaucratic reform of the health service in the past has failed. Why should another rearrangement of the deck chairs help?

In fact, British politicians and health officials would do better to adopt best practices from elsewhere. Progressive commentators used to boast that the NHS is “the envy of the world.” Roughly translated, that means they prefer the British system to the notoriously expensive American one. Right-wing US critics in turn sneer at Britain’s “socialized medicine.” Neither side has much to smug about these days, as slowing or declining rates of life expectancy in both countries demonstrate. 

As a satirist once observed, “there are two sorts of people in this world — those who divide the world into two sorts of people and those who don’t.” There are many other models for healthcare than the British or American systems — many neither wholly private, nor public, but containing elements of both. Yet in English-speaking countries, the debate has often been framed as a zero-sum game around two fallible healthcare regimes. 

Ditto, the domestic UK argument about funding. The Left says that the NHS over many decades has seldom been given the same resources as in France, Germany and the Netherlands, let alone America. And funding is marked by periods of feast or famine with predictable stop-go results. That’s, of course, correct.

The Right replies that billions have been pumped into the system until it consumes 44% of all taxpayers’ money devoted to the public services. Nowadays, spending levels are comparable with many continental European countries. And where health spending has been proportionately higher, in devolved Scotland with its preferential financial settlement, outcomes have been no better. That, too, is unfortunately correct.  

Last week, a report by the King’s Fund, a non-partisan think tank, argued that the UK has one of the lowest-cost and most efficiently run health systems in the world — less is wasted on administration than elsewhere — but it also found that the UK tends to have much poorer health outcomes than its peers, coming in 16th and 18th respectively for preventable and treatable causes of mortality in a basket of 19 comparable countries. 

Many causes of complaint are also found elsewhere. Aging populations mean more expensive treatments. Healthcare costs in most advanced countries are growing faster than the economy. 

But some problems are peculiar to the UK — and the US. Where America leads, the British have followed in gaining weight on processed junk food and struggling with diabetes. Public health is a neglected area due to Conservatives’ dislike of what they are pleased to call the “nanny state.” Every beneficial “nanny state” measure — from banning smoking in public places to compulsory seat belts in cars — was originally resisted by Tory libertarians. They wouldn’t dream of turning the clock back now, although they resist health interventions that would improve diets today.

Slowly, a consensus is forming about a better way ahead. Last year, the government passed legislation to join up GPs, hospitals, local authorities and charities across localities covering some 1.5 million people. Hospital beds won’t be freed up until social care can be provided for old people left in hospital wards. Homeless people should be housed and cared for before they become an expensive burden on the NHS. Other European countries do it. Why not the UK? 

Better use of new technologies, such as introducing AI to scale and apply complex interventions, and personalized care via the NHS app also promise to put the patient at the heart of their own treatment. The NHS also holds unique cradle-to-grave data on the population, an advantage given to no other health system in the world. It should use that knowledge to deliver better treatment. All of these efforts must be funded properly.

There is no panacea for all the NHS’s ills. But even at this low point, there are glimmers of hope. Getting mired in hopeless ideological debates and refusing to open eyes to the wider world would be the height of folly.

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This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Martin Ivens is the editor of the Times Literary Supplement. Previously, he was editor of the Sunday Times of London and its chief political commentator.

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