Like many readers, I owe my life to the NHS . I was born a few months premature in Watford General Hospital in 1999; I was back there a decade later with an appendix on the verge of bursting. In both cases, had it not been for the timely intervention of NHS doctors and nurses, I might not be typing these words today in time for the health service’s 75th birthday.
But hang on. 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 the heirs to Hippocrates who practice in it. That their employer is a state-run behemoth – compared to the public-private model found in most of the civilised world – is neither here nor there. It reflects our weird national relationship with the NHS that I could hold it responsible, rather than the men and women who staff it.
Other countries do not devote sections of their Olympic opening ceremonies to celebrating their healthcare systems. They did not spend their Thursday evenings during Covid going out to clap for it. They do not claim it is world-beating when multiple international rankings suggest it is poor at keeping people alive – which is, pretty fundamentally, its job – and when post-Covid waiting lists are hurtling towards eight million.
I hardly need to explain all this to you all. Those of us willing to openly pose as heretics from our national religion are no longer howling into the wilderness. We are no longer thriving off the occasional James Bartholemew column or buoyed by a Kate Andrews Question Time appearance. NHS scepticism is an increasingly common political phenomenon, with even Sajid Javid, the ex-Health Secretary, openly calling for wholescale reform.
Yet the MP for Bromsgrove is currently on his way out of the Commons, liberated to say the hard truths that his career-minded colleagues cannot. So it is of rather greater 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 outcomes for patients” under Labour.
Even Streeting’s gentle criticism of a service that delivered him less-than-stellar care during his own cancer scare has seen him branded, in his words, as “some sort of heretic” among his peers who worship at the alter of Aneurin Bevan. But it is amongst those on the left for whom it is perpetually the 27th July 2012 that most need to take account of the changing mood amongst the NHS’s most important audience: the public.
With waiting lists surging, a growing number are voting with their feet and using private healthcare. Last year, there were more ‘self-pay’ admissions for treatment than ever previously: 272,000, compared to 199,000 in 2019. In total, private hospitals had a record 820,000 inpatients and daycare patients as users paid for procedures such as cataract surgery, chemotherapy, and new hips.
Many Conservatives would laud those who choose to go private at their own 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 make for opposing the closure of private schools (asides from, y’know, what it would mean for the First XI). But this surge in private treatments is no altruistic move by high-minded middle-class BUPA enthusiasts.
In fact – as John Burn-Murdoch has highlighted – whilst UK spending on hospital treatments increased by 60 per cent overall between 2010 and 2020, it more than doubled amongst the lower-fifth of earners. In relative terms, the poorest now spend as much as the richest. The NHS’s failings are hurting exactly those Bevan hoped to aid with a system free-at-the-point-of-use.
Clearly, if an increasing number of voters are voluntarily opting out of the NHS, it has long-term implications for the sustainability of the model of a taxpayer-funded monolith. Voters will question why their taxes are at record highs if they still can’t get a basic operation. It is a fracturing in the social democratic compromise that underpins our political system – whichever party is in power.
That is not to say the public can now be easily converted to the cause of replacing the NHS with whatever alternative country’s model is the flavour-of-the-month in wonk-world. As James Frayne has often written for us, voters are convinced that the NHS – and public services more broadly – are riddled with waste and inefficiencies. But they will also naturally – and quite literally – cling to nurse for fear of something worse, raised as they are on a diet of ER horror stories.
A very Conservative sentiment, that. It’s true the Tories have made a great effort at eating into Labour’s self-image as the “party of the NHS” over the last decade. We had David Cameron’s three-lettered top priority, Theresa May’s 70th birthday present of a big wodge of cash, and Boris Johnson’s Damascene conversion to taxpayer-funding – all via a certain Vote Leave bus and Jeremy Hunt’s pin badge.
By the last election, Johnson and the Conservatives had become more trusted than Jeremy Corbyn and Labour with the health service. Had it not been for Covid, this may have provided a springboard towards an eventual programme of reform in a second Johnson term. Yet the lockdowns designed to protect the NHS have only helped to contribute to its broader, creaking collapse.
All the Western world is facing the problem of demography, as ever-larger – and sicker – older populations are supported by an ever-shrinking number of handsome young taxpayers (hello!). Politicians have been talking about serious social care reform for much longer than they have contemplated its NHS equivalent. Despite the best efforts of Andrew Dilnot, the can is still being kicked down the road.
For all Streeting’s warm words, he is not proposing anything more radical than nationalising GPs, pleading to the Treasury for more cash, and introducing a workforce plan suspiciously similar to the Government’s. Moreover, Labour has made clear they regard social care as a second-term issue. As with housing, the consensus is that something must be done, but nobody is willing to suggest what.
The sad reality is that the NHS is marking its 75th anniversary with record levels of funding, record waiting lists, and record dissatisfaction. It remains a fiscal blackhole that struggles at its basic task of keeping the ill alive. Any birthday clap rings hollow – and as do the words of any politician unwilling to admit the emperor has no clothes, and tell the truth that enduring another 25 years of this appalling system would be utter madness.