In the fifth largest economy in the world it seems reasonable to expect modern health care but this winter the United Kingdom’s National Health Service is failing yet again to deliver first world standards.

The NHS has been an almost daily news item since last December, providing horror stories such as the case of an 81-year- old woman dying at home after waiting four hours for an ambulance, and other similar stories involving patients waiting hours for ambulances. Hospitals have struggled to cope with a flu epidemic and an entirely predictable rise in patients during the winter months, leading to the headline target of 95% of Accident & Emergency patients seeing a doctor within four hours not being achieved.

NHS Crisis Normality No Longer Newsworthy

In response to the problems thousands of NHS staff and supporters marched through central London last Saturday to protest against the ongoing crisis. Their message was that insufficient funding and staff numbers are the root causes of this year’s winter chaos.

Surprisingly the march seemed to receive little coverage on national broadcaster the BBC, perhaps reflecting that the situation has continued for so long this winter that it has almost become a norm and lost its newsworthiness – in itself a reflection of the sorry state of the service during the winter in recent years.

Some people saw something more sinister, in what was at best a very strange omission by a national broadcaster known for its impartiality and comprehensive coverage of big stories.

 

And while the crisis continued Health Secretary Jeremy Hunt managed to find just the right words this week to antagonise already angry NHS staff.

 

POTUS v. The NHS

The problems have been significant enough and received enough coverage to attract the attention of Donald Trump, who felt the need to offer his own unique but predictably simplistic appraisal of the situation. Informed followers of the story were less than impressed, suggesting that the NHS, for all its faults, is better than the US system because it is based on the principle of universal coverage.

Medical Diagnosis: NHS Chronically Underfunded

More informed commentators have addressed the problems in a more detailed fashion. In January a letter to the prime minister from 68 senior accident and emergency doctors stated that patients are “dying prematurely” and that the NHS is “chronically underfunded”.

The letter outlined some serious problems, such as:

  • Over 120 patients a day managed in corridors, some dying prematurely
  • An average of 10-12 hours from decision to admit a patient until they are transferred to a bed
  • Over 50 patients at a time awaiting beds in the Emergency Department
  • Patients sleeping in clinics as makeshift wards
  • Queuing ambulances waiting outside hospitals, unable to hand over patients due to a lack of space and staff to cope with them

In one telling paragraph these senior consultants outlined the depth and seriousness of the crisis facing the health service, saying:

“The facts remain however that the NHS is severely and chronically underfunded. We have insufficient hospital and community beds and staff of all disciplines especially at the front door to cope with our ageing population’s health needs.”

To anyone not familiar with what has become an annual tradition in Britain, this will seem shocking, but unfortunately for British citizens, the problems mentioned have a tedious but still disgraceful familiarity to them.

A Sacred Institution in Secular Times – Britain’s One True Religion

In recent years, and under both Labour and Conservative governments, the NHS and its performance has been an issue of huge importance and controversy, with constant arguments about funding levels, waiting lists and how to achieve improvements. It looms large in most elections, to an extent hard to imagine in most other western European countries.

The NHS has almost sacred status in the UK, and repeated commitments to improve it and fund it adequately are an absolute must for all political parties, prior to elections and during the frequent political arguments about its current (often inadequate) state. Naturally health, along with education, welfare and perhaps defence spending are big issues in all countries, but for those used to a functioning health service as a given, meaning those in most of the wealthy countries of the world, the phenomenon of the NHS as sacred cow and permanently sickly child would be hard to understand.

Britain’s love affair with, quasi-worship of, and almost permanent political war about performance, costs and problems in the health service is possibly unique and slightly bizarre. Such is the extent to which it is ingrained in the national fabric that it was even included as part of the 2012 London Olympics opening ceremony. Of course the hard work of doctors and nurses, who are over-worked and underpaid in many countries, should be appreciated, but perhaps only in Britain could what is taken for granted in most rich countries – care for the sick – be elevated to the subject of national celebrations.

This special status can be largely explained by its origins as the gift of a Labour government after the second world war, bringing health care to millions of poor people across the UK who had previously struggled to afford it. Seen then as a huge and significant step along the road of socialist progress, it is now a national institution which no government dare to question. Despite arguments and anger about the level of private medical provider involvement in the NHS, the basic principle of universal care for all is beyond political debate.

A Large Dose of Honesty and Radical Surgery?

Much is often made in Britain of the fact that the NHS is “free at the point of use” and must remain so. This is a slightly romanticised and politically charged description for a service which is paid for by taxes and other employer/employee contributions, as in most countries. It is free at the point of use, meaning there are no checkouts in hospital reception areas, but it is not free in any true sense of the word.

Many other countries in Europe and elsewhere fund health services through taxation and employer/employee contributions, although in many countries there is transparency about the amount individuals are contributing specifically to health services. Such an arrangement, where people can see the real cost of their health care, as opposed to political arguments about x millions spent this year and last year, might well be beneficial and encourage an open debate about costs and results. The UK political football approach of trading shouted figures in parliament about who spent what when has not dealt with the problems on the ground.

The search for answers to this perennial problem leads directly to one significant statistic. Britain, with a health budget of around 9% of GDP, is spending slightly below the EU average and seemingly managing to achieve well below average results. But the disaster of this winter, last winter and others cannot be explained away entirely by a few percentage points of GDP. There are undoubtedly parts of Europe where healthcare is probably worse that in the UK but the wealthier countries, which are a reasonable measure for the UK, do not seem to have suffered from queues of ambulances, patients treated in hospital corridors, protest marches and angry letters to the government from senior doctors.

To solve this reoccurring bout of the NHS’ winter fever, and the long-term funding level problems, there needs to be a large injection of funding, a greater degree of transparency about individual citizen’s contribution levels (such as in European compulsory insurance schemes) and an honest national debate about the real costs of a high quality health service and how to cover them. If at all possible, particularly in a centrally run country like the UK, there needs to be more autonomy from political interference.

Social care issues, which mean that some elderly patients cannot be released from hospital due to insufficient care home spaces, are leading to so-called bed blocking and exacerbating the NHS’ problems. Here too funding is an issue, underlining the size of the problem facing a government with low growth predictions and many other serious challenges to address.

In advance of an honest debate about what the country wants and can afford, an impartial body of experts should conduct a review of why the NHS, apart from the obvious staffing and budget difficulties, seems to lag behind some of the higher spending EU countries. Politicians of all persuasions should be kept away.

Some input from experts in the EU might be useful, as many countries seem to have a better story to tell, and a potential fringe benefit would be the signal that the door to the EU has not been slammed shut by all. Contributions from any country which runs a high quality health service based on a belief in such as a human right should also be welcomed

To take this step those in UK still living in denial would have to be prepared to put the misguided “envy of the world” slogan away once and for all. This is a delusion which crosses the political spectrum and is sometimes used by those fighting against the current funding problems, not just those in government trying to deny they exist.

However admirable the founding principles of the NHS were, as embodied in its 1948 constitution, the events of recent months have been a stark reminder that in its current state it is not the envy of anyone or any country.

For its patients and staff it is beginning to represent a broken institution, becoming more decrepit with each winter and an illustration of national incompetence, albeit mainly for want of funding and not the professionalism or dedication of its staff. For foreigners aware of its predicament, at least those with a more finely tuned intellect than Mr Trump, it is probably viewed with a mixture of sympathy and incomprehension.

A picture speaks a thousand words and nobody who has seen the pictures of patients on trolleys in corridors, ambulances in queues outside hospitals, angry NHS staff marching and government ministers mentioning meaningless extra millions, would put envy anywhere on their list of initial emotions.

It’s worth remembering where this story began, with the formation of the NHS in 1948, and noting the final sentence of the letter sent to Theresa May by dedicated doctors who still believe in the founding principles.

We remain hopeful and committed to improving the care of patients in Emergency Departments throughout the UK.

“The NHS belongs to the people…..it touches our lives at times of basic human need when care and compassion are what matter most” 

The NHS Constitution, 1948.