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NHS reform is off the agenda. Our peculiar healthcare system will carry on much as now, revered at home and pitied abroad. There had been speculation about who would take over from Sir Simon (now Lord) Stevens, the outgoing chief executive of NHS England. Defenders of the status quo were outraged that the post might go to Dido Harding, a businesswoman and Tory peer.
Instead, the healthcare blob has plumped for the ultimate continuity candidate, Amanda Pritchard, Sir Simon’s deputy. The Guardian seems delighted, as are healthcare workers’ unions. Ms Pritchard is the insider’s insider: apart from a brief stint on Tony Blair’s Delivery Unit, she has spent her entire career as an NHS manager.
Nothing especially surprising there. Public appointments tend to go to insiders. Civil servants and quangocrats generally promote people who share their own assumptions: that most problems can be solved by higher spending; that Brexit was a catastrophe; that “diversity” means “people who look different but think the same”; that private enterprise is a necessity to be tolerated rather than a virtue to be celebrated. Dominic Cummings went into government to dismantle this imperium in imperio. He failed.
I should add that I have never met Ms Pritchard, and I have no reason to doubt her abilities. I wish her every success. I simply observe that hers is a change-averse appointment. The vast sums being poured into the NHS will not be accompanied by any meaningful attempt to make it more responsive. The Government is reflecting the public mood, which is that “Our NHS” must be defended in every aspect, right or wrong.
Of late, it has got a lot wrong. The epidemic revealed structural problems that other countries did not face, at least not on the same scale. Our state agencies messed up the early procurement decisions. They made a hash of testing. They failed to get their hands on enough PPE until after demand had peaked (the stuff is now overwhelming our storage capacity, unused and unwanted). They sent infected patients into care homes. The only thing that went really well was the vaccine purchasing programme, which ministers did not leave to the NHS or PHE, but instead contracted out to a venture capitalist.
Those early failures provoked cognitive dissonance in our commentators. On the one hand, they could see that Britain was being outperformed by comparable countries. On the other, they could not bring themselves to think ill of the NHS. So, with a neat mental sidestep, they attributed the NHS’s myriad mistakes to “the Government”, as though Matt Hancock were personally depriving nurses of the equipment they needed. The country at large cheerfully embraced the same doublethink, fulminating about failures while clapping carers.
Fair enough. Individual clinicians are hardly to blame for a substandard system. We ought indeed to be grateful to hospital staff working long hours in unusually stressful circumstances. Yet it should be possible at the same time to recognise that their talents might be put to better use in a less rigid system.
Opponents of reform are good at blurring that distinction. Make any criticism of NHS structures and you are “attacking our hard-working doctors and nurses”. Yet, long before the epidemic, the weaknesses in the NHS were plain to see in international league tables. Our survival rates for cancer and heart disease were well behind other developed countries’. In February 2020, immediately before the epidemic hit, 4.7 million people in England were waiting for routine operations.
It was this fragility that dictated the severity of our lockdown. We consented to house arrest in order to “protect the NHS”. In the rest of Europe, people saw it the other way around: their healthcare systems, they assumed, were there to protect them. For all our dutiful applause, we knew, on some level, that we couldn’t afford that attitude.
I happened to notice last week that the seven-day rolling death count in Sweden, which had been in single figures since May, had fallen to zero. I called an MP friend in Stockholm to ask what their secret was. “We basically followed Britain’s pandemic plan,” he said. “The difference is that we stuck with it, but you abandoned it after a couple of weeks. I guess we were more confident about the ability of our hospitals to cope”.
He said it matter-of-factly, as Europeans do when talking about Britain’s healthcare system. Sweden was unusual in avoiding lockdown, but most Continental countries had lighter restrictions than ours. Given that the sole justification for the prohibitions was to prevent hospitals being overwhelmed, this is telling.
Ministers knew that Britain was more vulnerable than countries with mixed healthcare systems, but they could not say it aloud. So they, too, went along with the national doublethink, praising the NHS as heroic and world-beating while, in practice, treating it as unusually fragile.
When I was an MEP, I was often struck by the fact that no mainstream socialist party on the Continent wanted a British-style healthcare system. A few Greens and Communists argued for fully nationalised provision, but social democrats preferred systems that brought private and public hospitals together, or that allowed for a measure of insurance.
In Britain, we refuse to countenance that idea. Perhaps we have convinced ourselves that free healthcare for the poor is somehow a unique property of the NHS (it isn’t – it is common across Europe). Perhaps, conscious that we paid nothing for our last appointment, we don’t wish to appear ungrateful. Perhaps we are simply habituated to the status quo, and are exhibiting a very human fear of change.
Whatever the reason, we plainly want to keep the current system, in which treatment is rationed by queue, capacity is always on the point of being exceeded and patients are expected to be thankful for the provision services that are elsewhere taken for granted. We can hardly complain, then, when we get what we demand