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It’s easy if you try
Imagine a Britain without the NHS.
A Britain where the state did not directly employ or contract nearly every doctor and nurse in the entire country.
A Britain where the government did not decide which cutting edge treatments would be offered to the public, and which ones were simply too expensive.
A Britain where citizens were not reliant on the state for the physical delivery of nearly all their healthcare needs.
A Britain where healthcare was unconstrained by politically influenced national targets.
A Britain where angry, jealous talk of “postcode lotteries” did not act as a brake on excellence or a requirement for dull, uniform mediocrity.
A Britain where every hospital superbug or missed A&E waiting target did not automatically become the prime minister’s overriding personal concern, freeing them up to actually be a world leader.
A Britain where we are able to have a rational, level-headed discussion about healthcare, and what kind of system would achieve the best outcomes for the most people at an acceptable cost.
A Britain where we understood that healthcare need not be a choice between the NHS and the infamous US system.
A Britain where we were able to take inspiration from the best aspects of different healthcare systems around the world in reforming our own.
A Britain where criticism of the NHS was not treated like blasphemy, with the offenders shamed on social media and their political careers curtailed.
A Britain where we gave nearly as much respect, honour and resources to our armed forces and veterans as we do to the NHS.
A Britain where we did not reflexively worship a giant, mid-century bureaucracy as our secular national religion.
A Britain which thought enough of itself to realise that there is far more that marks us out as a powerful, great and indispensable nation than our anachronistic 1940s healthcare system.
A Britain where lean, efficient public services existed to serve the people, rather than we the people existing only to serve our insatiable, rapacious public services.
A Britain where saying “the NHS served us ably for many decades after the war, but now it is time to look again at how we provide healthcare to our fellow citizens” was not a shocking, unacceptable statement.
Imagine a Britain where the link between politics and healthcare was broken and the NHS monopoly split up, meaning that things like the coming national strike of junior doctors could never happen.
Just imagine what could happen – all that we could accomplish – if only we were able to have a calm, rational conversation about healthcare in modern Britain.
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Further reading:
Our deadly obsession with the NHS
A Haidtian take on ‘NHS worship’
Worshipping the NHS costs lives
Britain’s cult-like worshop of the NHS must end
To save the NHS, let’s stop worshipping it like a god
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Short version: I agree that there needs to be a debate on the healthcare system in this country (in dire need of reform), that does not automatically presume the basic NHS model as sacrosanct. However, I am not yet convinced that the basic NHS model is yet definitively out of date and in need of scrapping, with appropriate reforms.
You also hit my crazy rant button again, but this time I really will keep it to myself… until such time as I can be bothered to post the long version.
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Curious as to how I managed to hit the rant button when I simply advocated a calm, rational debate about an important public service that doesn’t lapse into schmaltzy sentimentality about “our NHS” – but I guess you sensed the direction I would like things to go.
I’ll look forward to the long version when you have it ready – any sane contributions to the healthcare debate are always welcome!
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Actually the “rant button” thing was mostly a joke at my own expense, mocking my tendency to take some small part of your argument – namely, in this case, the bit about honouring the military and resourcing it more- and going off at a tangent. (In which case, to keep things as on-topic as possible, I think the solution to the military funding problem could just as much be about the government’s tendency to interfere politically and militarily in the affairs of other parts of the world, and on the other hand spending so much of our defence budget on what seems to me to be a white-elephant nuclear deterrant in stead of on more conventional forces, not so much the fact we over-fund a bloated NHS per se.)
(You are right to advocate a calm, rational debate on the NHS which avoids sentimentality, and do so in a calm, rational manner. I have no problems with that!)
I don’t know if, in retrospect, I can really do a “long version” but there is a couple of suggestions that were on my mind that was worth suggesting. One is what was suggested in the Panorama special a few months back- combining health and social care so as to provide more care-in-the-community solutions for the elderly and those with long-term health conditions, plus a greater focus on prevention, so as to reduce the need for hospitals and other such services. The other is one which was admittedly advocated by some unionist/old-school social-democrat type, which was that the practice of “internal markets” was actually wasteful (I think because it meant having to hire consultants just to enable the process to work, plus all the associated marketing costs. All the latter possibly suggests, though, is the fact that the “worst of both worlds” approach advocated by New Labour and Tory-lite governments doesn’t work- either have the old-style model and have it focus exclusively on the nitty-gritty of providing healthcare, or have a true market-based system which becomes efficient by means of market forces.
I don’t know what the real solution is, though perhaps the sort of single-payer system you seem to advocate is a good posible solution. I however think the default solution to bad government is not less government rather than improved, better government.
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Another bit I had thought of adding to the “long version” was that I am worried that privatization can lead to a sort of “gravy-train mentality”, by which I mean that for-profit companies whose rasion d’etre is maximizing shareholder value will inevitably seek to get as much as it can from state funding, given the state is (supposedly) about providing the best possible service irrespective of cost. Thus, there is a tendency for governments to throw money in this hope, and it ends up costing more than it would have done if the private sector were never involved. (A good example would be the PFI shenanigans.) The question is, how can government fund private contractors whilst being careful they do not overcharge for their services? (I suppose you could suggest this is already done with things like dentistry and optical treatment).
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You raise a good point. I think that as with any outsourcing deal (and I’ve worked for a decade in the BPO industry) it comes down to whether the client and provider negotiate a good deal. It’s vital that the Service Level Agreements both measure the right things and incentivise the right behaviour from the supplier. With PFI, prison contracts and too much else, government has clearly been so focused on the bottom line and short term savings that all other considerations – like the astronomical long term cost of PFI – went out the window. This has sullied the name of privatisation and outsourcing, when really it is incompetent government negotiation which is to blame.
While outsourcing and privatisation can lead to the problems that you are worried about, this is not inevitable. In fact, the more the state contracts out services to nimble private and third sector providers, the better it will (should…) become at negotiating deals which deliver the best outcomes at the best prices for the taxpayer.
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