Last autumn, a survey tried to identify the 50 things that make Brits feel most proud to be British. The list contains a lot of entries that fully deserve to be there: “proper pubs”, “roast beef”, “the Lake District”, “James Bond”, “Harry Potter”, “real ale”, “the Salvation Army”, “Worcestershire Sauce”, “Hadrian’s Wall” – all excellent stuff.
But it also contains two embarrassing entries that really should not be there: “beans on toast” and “the NHS”. Come to think of it, the former is actually fine, given that it is almost certainly meant ironically. But the NHS tops the list by a wide margin, and I’m afraid people mean it.
The NHS. Seriously? Would that be the same NHS that is currently under investigation again, on the Health Secretary’s order, after an unusually high number of avoidable infant deaths at one of its trusts? The same NHS where standards of maternity care are, according to the Care Quality Commission’s Chief Inspector of Hospitals, often “truly shocking”? The same NHS that gave us Mid Staffordshire?
We are normally proud of things that are, in some way, exceptional. That’s why real ale is on the list, while Carling is not. Genuine question: what’s exceptional about the NHS?
The fact that it’s universal, that it provides care to everybody irrespective of ability to pay? Standard fare. All healthcare systems in the developed world do that, with the US system being the only major exception.
The fact that it is generally free at the point of use, with very little out-of-pocket spending? Nothing special either. Plenty of systems are, or where they have modest co-payments, they exempt people on low incomes and/or with high health needs.
The fact that it offers modern technology and modern medicines? Meh. All healthcare systems in the developed world do that, and plenty of them are more innovation-friendly than the NHS.
The fact that it runs on compassion and solidarity, rather than self-interest? Give me a break. Of course it runs on self-interest. Let’s do an experiment: let’s cut doctors’ pay by a quarter or so and see how many of them would still turn up to work.
Now, if it delivered impressive outcomes, that would indeed be a reason to be proud of it. The Swiss have good reasons to be proud of their healthcare system. They have the lowest rate of (healthcare-related) avoidable deaths in Europe, possibly in the world.
The Dutch have good reasons to be proud of their system too. It is an exceptionally generous system which offers fast access to a broad range of treatments.
The Japanese and the Israelis have good reasons to be proud of their systems. They achieve phenomenally good survival rates for cancer and stroke.
And then there are the French, German and Belgian systems: not spectacularly good in any one particularly category, but consistently good across the board.
The NHS? Nearly always in the bottom third of the league tables, usually about on a par with the Czech Republic and Slovenia.
But what about the Commonwealth Fund study, which rates the NHS as the best healthcare system in the world? The Commonwealth Fund study is the outlier among health system rankings, because it pays little attention to outcomes – it is mainly based on survey responses and general system characteristics. But it has one category which does relate to outcomes, and in that category, the UK comes out 10th out of 11 countries. So even the preferred study of NHS cheerleaders confirms that in terms of outcomes, the NHS is one of the worst systems in the developed world.
“But it’s just because of underfunding!” I can hear you protest. Not so. Yes, some countries spend more money on healthcare than the UK. More money makes a system more generous. But it does not automatically make it better at dealing with its core functions.
In fact, in efficiency rankings, the NHS also comes out in the bottom third, just as it does on outcomes. Yes, maybe we should spend more money on healthcare. It cannot do harm. But it would not, on its own, sort out the system’s main problems.
The jingoism of Little Englanders is sometimes unedifying, but it is not nearly as cringeworthy as the NHS patriotism of the left. The NHS is the country’s most overrated institution. It is the Carling of healthcare systems. It achieves nothing that dozens of other healthcare systems do not also achieve, and usually better – and it’s time we admitted that to ourselves.