What did you do this Christmas? Gorge on turkey with family, friends and loved ones? Engage in passive-aggressive political debates about Nigel Farage and UKIP with distant relatives? Test to the limit the human body’s ability to break down alcohol? Well, in between doing some or all of those things, a huge number of Britons also found the time to take to social media and publicly declare their love for one particular public service. The object of their affections is, of course, the National Health Service, about which only positive things can be said and to whom we must all be seen to pay sufficient homage.
For the past month, your blogger’s Twitter feed has been inundated with schmaltzy love letters to the NHS, shared and retweeted countless times by people in the grip of a dangerous herd mentality and the gnawing fear that failure to participate in the semi-compulsory Christmas love-in will lead others to believe that they are secretly in favour of cancer, or that they really Hate the Nurses.
Fortunately for these people, but less so for the rest of us, there are countless ways in which they can publicly display their unthinking fidelity to one very specific model of universal healthcare provision dreamed up in 1948.
They can post pseudo-inspirational images on our Twitter and Facebook timelines, like this one:
Or this one:
There are many more besides. Then, once we have demonstrated our loyalty on social media, we might join in a rousing chorus of the NHS song together (how long until the NHS is given its own official anthem, one wonders):
Or perhaps we might perform some cringeworthy street theatre with our chums (sample below) to display our Conservative-hating credentials and warn off anyone else who might harbour thoughts of tinkering with the system:
Patient 3: (in blood soaked sheet) No no! Help help!
Cameron: You can manage without anaesthetic! Who needs expensive equipment! You don’t need any training
Chorus chant: When we’ve got to make a profit just like the USA
Lansley: Yes you have to make a profit! Just like the USA
I will make a killing while patients die on the floor Cos the NHS that you love so much Just won’t be here any more Yes you have to make a profit! Just like the USA
Chorus chant: Chop up the patient – kill or cure
Because the NHS won’t be here any more
Auctioneer: Roll up ! Roll up! NHS for Sale! NHS for Sale!
In fact, the mere mention of the National Health Service is often enough to make otherwise sensible people and organisations lose the plot completely, as is ably demonstrated by this atrocious piece in the Guardian, purportedly giving us 65 reasons to love the NHS on its 65th birthday. Among the reasons given:
15. Abortions were made legal on 27 October 1967.
29. The NHS is one of the largest employers in the world, along with the Chinese People’s Liberation Army, the Indian railways and the Walmart supermarket chain. Because the fact that one in every twenty three people of working age toils for just one branch of the government is something to be celebrated.
42. In November 1982, your correspondent was born with jaundice in an NHS hospital in east London. Discharged a few days later with a healthy brown complexion. Thanks, NHS. Were it not for the NHS, of course, the jaundiced infant would have been carelessly tossed in a skip and left to die.
64. The average life expectancy has increased by at least 10 years since the NHS came into existence.
65. It’s just bloody marvellous, isn’t it?
Well, there you go. The sample of reasons to love the NHS given here are entirely representative of the tedious remainder in the article. Some of them have nothing to do with healthcare at all, and the rest tend to give the NHS credit for innovations in medicine and medical technology that would have taken place whether the NHS existed or not.
And yet this cheap propaganda works, and works well. The cumulative effect of the incessant pro-nationalisation PR and NHS hagiography is the creation of a climate where even the most ardent believer in small government pauses and thinks twice before saying anything at all about the state of healthcare in Britain, even if it is only to propose modest tweaks or improvements.
Indeed, if you have a political death wish, there can be few more effective ways to alienate former allies, generate negative headlines and haemorrhage precious Twitter followers than to speak in anything less than effusive terms about the NHS, Britain’s creaking, dubious Wonder of the post-war World. In today’s Austerity Britain, you don’t even have to go as far as questioning the principle of socialised healthcare to find yourself well outside the range of tolerated opinion and marked out as a political pariah – simply suggesting moderate reform or questioning the ringfencing of government healthcare spending at the expense of other departments will do the job quite nicely, seeing you swiftly excommunicated from public life.
Imagine, for a moment, that following the Rotherham sexual abuse scandal revelations, the public’s response had not been one of anger and calls for immediate answers, but the holding of a prayerful candle-lit vigil in support of the South Yorkshire Police force and the local borough council. Or that after the circumstances of the deaths of Victoria Climbié and Baby Peter became known, the British people had reacted not with fury and concern but had instead rallied around in defiant support of Haringey Council’s Child Protection Service.
Surely, you might think, we would never witness such a dystopian response to institutional mediocrity and near-criminal incompetence in modern Britain. But of course we do see it all the time, for there is one realm of Britain’s public sector that is not only effectively immune from criticism and implacably resistant to reform of any kind, but which holds such sway over our collective psyche that facts, evidence and reason go out the window before a serious discussion can even begin. And in place of reason and dispassionate arguments about how best to provide healthcare for a country of over 60 million people, instead we have candlelit vigils and public campaigns for the very organisation that we should be holding to account.
Earlier this year I participated in a television debate on London Live, at the time of the People’s March for the NHS, a recreation of the famous Jarrow march but this time devoted to preserving the NHS in its current form for all time. At one point I point-blank demanded to know whether there was any theoretical NHS reform, hospital or service closure that my opponent would accept in pursuit of overall better health outcomes for the British people, aside from never-ending above-inflation funding increases. The response? A petulant silence:
In fact, petulance seems to be the most common reaction whenever the subject of reforming the NHS is broached, or when someone dares to question the latest national sacrifice we are told to make for the benefit of the health service. If ever some brave soul speaks out against another punishing tax hike, the Cult of NHS is there to push back: “But our NHS needs it“, we’re told. Just make this one more sacrifice for the NHS. And if that turns out to be insufficient, make another one, and another. You should feel honoured to be pouring your money into such a humanitarian system, so stop complaining.
(Incidentally, those who complain about NHS pay freezes due to austerity but then simultaneously campaign to ensure that the private sector never get a look-in are shooting themselves in the foot – if frontline staff were employed by private companies there would be no direct political or fiscal need to impose such blanket pay restraint as there will always be with a state-operated, politicised NHS.)
But perhaps there are still some others who have not yet been indoctrinated into the cult. Perhaps there are still those who think that the greatness of Britain is based on much more than the quality of her public services, and that it is our artistic, cultural, commercial, scientific and geopolitical contributions to the world which mark us out as a truly great nation. Perhaps some people suspect, though they dare not say, that another billion pounds wrenched from education or defence or squeezed from the public through endlessly inventive new taxes and blindly thrown at our ravenous National Health Service is not the automatically positive thing that we are told.
If such people do exist in any number, their views are certainly not shared or reflected by any political party desperate for their votes. Labour, having founded the NHS in 1948 and emptied countless rooms boasting about it ever since, still fancy themselves as the party best placed – or even destined – to set it in aspic for future generations. Even during their peak period of ideological coherence under Margaret Thatcher, the Conservative Party showed no inclination to tackle the great elephant in the room, even when they sought to privatise other state-owned assets and industries. And UKIP, that one-time libertarian, small government-championing party, now like to claim that they are the only party who will “protect the NHS” from the big two, so far have they deviated from their ideological roots in pursuit of the disaffected Labour vote.
With every single major political party clamouring about how they are the only ones who can be entrusted with the NHS, it is somewhat remarkable that we are still told by numerous fearmongers that the 2015 general election could see the end of healthcare free at the point of use:
At present, far too much of the public debate about the NHS (where such a debate exists at all) goes something like this:
Person 1: Maybe we could take a few actions to make our healthcare system better, or learn something from the healthcare systems of other countries.
Person 2: How could you be so heartless as to suggest that we embrace the awful US healthcare system?
Person 1: But I never said anything of the kind.
Person 2: You want people to have to swipe a valid credit card before the ambulance takes them to hospital!
In today’s Britain there should be room for a range of views and stances on healthcare provision, and no politician or citizen should feel compelled to keep their opinions within the extraordinarily narrow range of approved thought that is currently permitted. It should be possible to say that one believes in the principle of healthcare free at the point of use, but that the state should stop crowding out other providers from a range of backgrounds (private or nonprofit) who may be able to provide a superior service. And it should be obvious that questioning certain aspects of the current system does not indicate a desire to start emulating the United States, who even after ObamaCare have one of the worst healthcare systems of any country in the developed world.
Tom Chivers sets out an argument for just such an incremental reform approach in this 2013 Telegraph piece:
With a fundamentally not-that-bad system like the NHS, major reforms are likely to do more harm than good, especially since the next lot won’t give them time to work before they say the reforms aren’t working and it’s time to have some new ones.
But you can tinker, and you should. Competition and markets and good incentives, cleverly designed, might well improve the system, and should be tried in small areas, allocated at random. Insurance and savings systems similarly could be brought in locally. If it works better than a centralised, socialised system, then it could, slowly, spread throughout – and, finally, replace – the NHS.
Chivers also pushes back on the idea that we should “love the NHS”, or indeed any particular government service:
But there’s something a bit strange about saying that we love it, as campaigners are saying at the moment. Love the NHS? What does that even mean? It’s like loving the British Army or HM Revenue and Customs: it’s a large and important public body which plays a vital role in our society, not a human being, not a family member. If we were offered a replacement which could be easily put in place and which would do the job better, we should take it, without sentimentality, just as we do when we buy a new laptop or dishwasher …
Saying we “love” the NHS just gets in the way of treating it dispassionately, of pushing it aside when it gets out of date: it becomes, instead of a faceless system, a faithful old dog that you can’t bring yourself to put down. Stop saying it. Say: it works. Say: smashing it won’t help. But also, say: if something better turns up, we’ll take it, and never look back.
This is the season of peace and goodwill to all men, and some will no doubt question the motivation for publicly doubting the Twitter-enabled worship of the National Health Service at this time, or find it unseemly – or “Why Does This Crazy Right Wing Blogger Hate The Nurses?”, as the Huffington Post might screech. It would certainly be much easier to join with those who consider the retweeting of a picture thanking NHS staff for working over the Christmas period, or glibly proclaiming that I am somehow indebted to the NHS because I was born in an NHS hospital (as though my taxes hadn’t since paid for it and as if there would have been no alternative in its absence), to be a meaningful and substantive contribution to the healthcare debate.
But it is only right and proper to take a vociferous public stand when one witnesses an outbreak of mass lunacy combined with misplaced moralising – and to do so when the offence takes place, not just from a comfortable, uncontroversial distance of days or weeks hence.
A recent Twitter conversation I had with an ardent NHS fan is quite revelatory:
The lady with whom I was debating was perfectly charming and very sincere in her beliefs, but her line of reasoning is undermined by a yawning non sequitur. Such people seem stuck in an infinite “private firms = profit, profit = bad” loop which causes them to totally overlook what should be an obvious point to anyone: that if the state truly does provide the best healthcare at the lowest cost it has nothing to fear from the private sector, and that if the private sector is capable of delivering better outcomes in certain cases the government has a moral and fiduciary responsibility to its citizens and the taxpayer to purchase those services rather than trying to deliver them itself. The government should certainly not be in the business of sacrificing or degrading the lives of its citizens on the altar of a misplaced ideological commitment to nationalisation.
The well-meaning but misguided public movement that unquestioningly supports the status quo, this moralising army of online NHS priests and priestesses, are part of Britain’s sickness, not her cure. They, like so many Britons today, have been raised and encouraged to believe that everything good comes from the state, and that there is something inherently dirty and untrustworthy about private enterprise. They subscribe to a false world view which believes there is only a fixed amount of money in circulation, and frets that any money received as profit must automatically mean less money being devoted to front line services.
It is long past time for the British people to disenthrall ourselves of these false dogmas, if we are truly serious about maintaining a world-class healthcare system at the heart of a prosperous country.