One of the commonest accusations levelled against the Conservative government by their political adversaries is that they’re trying to dismantle the NHS… if only that were true. Personally, I didn’t realise it was scientifically possible for an organisation to be so inefficient until I started working in it.
The whole system is broken, and more money is the last thing it needs. Indeed, you could divert the entire national budget to the NHS and it would still swallow it up and ask for more. At present it is being held together by rubber bands, sellotape and blu tack, along with the remarkable good will of its long-suffering doctors.
At this stage I honestly believe it would be better to burn it to the ground and start from scratch than allow this bloated, decaying zombie to continue lumbering on. As an NHS doctor myself, I’d be the first to pile up the kindling and upend the barrels of gasoline.
I've recently graduated from medical school and have been working as a junior doctor for the past three years, and I can tell you the sheer scale of waste and redundancy is truly indescribable. It's almost as if they're deliberately trying to waste as much money as possible.
The problem is they're the only game in town, and they know it. Private healthcare is extremely rare in the UK compared to other developed nations, and with no competition there is no incentive to improve efficiency. Middle/upper managers on six-figure salaries are rife. Their very existence is seemingly predicated on pushing bureaucratic documents to one another and wrapping the organisation in as much red tape as they can, but certainly having nothing to do with improving patient care.
I long ago lost count of the occasions where, as a student, I was sat in a specialty clinic documenting one DNA (Did Not Attend) after another. I may have been paying £9,000 a year for the privilege, but the consultants I was shadowing were often on £100/hour locum rates. Not that it’s the doctor’s fault, it’s simply that patients face no negative consequences for not showing up. We just rearrange the appointment for them. If even a £5 deposit was collected beforehand, you’d see drastically fewer no-shows being recorded.
Amidst all of this is the fact it isn't a national health service at all, but an international one. People come from all over the world to take advantage of our generosity, laughing all the way here and even harder on the way back. Most of the clinicians I've encountered seem to think this is a lovely arrangement. I’ll admit we doctors, as a species, tend to be appallingly politically-correct, and care not a jot about the wider opportunity costs, rather on treating the patient who happens to be in front of us.
Though as much as health tourism is an issue, and a bigger one than the higher ups like to admit, it pales in comparison to rising population as a whole. I remember in a med school lecture about supply and demand pressures in the NHS, I once asked whether the unprecedented scale of mass-immigration seen over recent decades might be having a role in increasing demand, and therefore waiting times and budget pressures. The lecturer looked at me as though I’d just proposed resurrecting the Third Reich, and told me it was a totally inappropriate question even to be asking.
You learn your lessons fast when your entire career is at stake. The older doctors closer to retirement are better at saying it how it is, as they have less to lose, but for those with our careers ahead of us rather than behind, it is better to keep one’s head well below the parapet. One of my (black, as it happens) colleagues working in an obstetric ward in East London confided in me that, in her entire four-month placement, she saw but one baby delivered to an English-born mother, and her ethnically Somali.
Woke ideology grows and metastasises daily. Last year alone NHS management thought it a fine use of taxpayer’s cash to spend the better part of £46 million on diversity and inclusion officers. Indeed, doctors and nurses must now attend mandatory classes teaching us how all of the world’s woes can be laid at the feet of the straight, white, male untermensch.
But the main, apparently insurmountable problem is that the NHS has become a political sacred cow, impossible to criticise without being decried as a blasphemer. The mistake (often deliberately) made, is to confuse the NHS with the people who work for it. The latter are often dedicated, compassionate and hard-working, the former is an obscene monstrosity. I wouldn’t put much hope into bipartisan cooperation either, the day the Labour Party stops weaponizing the NHS is the day they stop being the Labour Party.
Whenever one discusses even partial privatisation, people invariably point to the States. As though the US healthcare system is the only alternative option out there. Ignoring Australia, New Zealand, Spain, Japan, etc. If America is too far one end of the spectrum, and I would argue they most assuredly are, then we are certainly too far to the other.
Take Canada for example: a mature, competitive insurance market means premiums are relatively cheap, and more than two thirds of the population has some form of private health coverage, it’s a normal part of employment contract negotiations there. They also have an excellent public healthcare safety-net for those without insurance.
This takes a tremendous amount of pressure off the public healthcare system, which as a result makes it more agile, streamlined and efficient, with some of the best outcomes in the world. In Britain however, the system is the safety-net, which is why it’s always creaking at the seams. Less that 10% of people have private coverage, mostly the extremely wealthy, and little competition between insurance companies means sky-high premiums as a result, meaning only the super-rich can afford it, exacerbating a negative cycle of unaffordability.
There is a very weird stigma against private healthcare in this country, but think of it this way, would you pay £50 to see your GP the same day you need them? Would you pay £500 to ensure your knee surgery is next month rather than next year? I suspect for many people the answer is - where do I sign?
Needless to say the NHS is not free, it is actually phenomenally expensive. Well over £150bn per annum in fact, which is more than the whole of education and national defence combined, or £3,840 for every man, woman and child in Britain. The real question is, how do we get the most out of what we put in? If integrating the private sector into the public one does that, as proven to be the case in other developed nations, then so be it.
During my elective in Australia, the doctors used to laugh at the NHS, saying it was like a cult. No other clinicians in the Western World would put up with such poor working conditions for such poor pay, they said, and it’s only the goodwill of the indoctrinated cult members, along with an endless supply of public funds, keeping it afloat. Their own hospitals are packed full of expats who have broken free from the commune, many saying they had no idea how bad it truly was until they got out. The more I've experienced of it the more I have to agree with them.
In the 17th Century the French statesman Count Mirabeau observed of his teutonic neighbours ‘some countries have armies, but the Prussian army has a country.’ Three hundred years later, some countries have health services, but the British health service has a country.