By Tom Mitchell
The American Nobel Prize winner Sinclair Lewis wrote in 1917 that “winter is not a season, it’s an occupation”. For the 1.5 million NHS workers in the United Kingdom, this will ring painfully true – a letter last week from senior doctors declared “some of our own personal experiences range from over 120 patients a day managed in corridors, some dying prematurely.”
Chris Hopson, the chief executive of NHS Providers, said that ‘things got so tough in the NHS last winter that we said: “never again’”. Only Chris Hopson will know whether this was an ingenuous ambition, but for the majority of the population, the NHS ‘winter crisis’ has become an annual certainty of patient hardship and political squabbling. As per tradition, this winter has borne witness to missed targets, the cancellation of thousands of planned operations and anecdotes of patients dying in corridors.
This is despite the fact that the NHS is supposedly the “envy of the world”. France, Germany, Sweden and practically every other Western European country whom Britain might consider a contemporary manages to negotiate winter without an annual debacle of huffing, puffing and finger-pointing. Given that these countries also have winters (often harsher than our own), the conclusion must be that they are better equipped to deal with the increased demand.
The standard explanation is that their systems are better funded. This is to some extent true – Britain spends approximately 10% of its GDP on health, which is slightly less (but only slightly) than the likes of France and Germany. However, the difference in funding is not significant enough to explain the vast disparities in outcomes, particularly given that Britain’s spending on health exceeds that of the average amongst OECD nations.
Nor should we pretend that these deficiencies are limited merely to a winter squeeze: for example, the Euro Health Consumer Index found that the UK came 14th in Europe “mainly due to poor accessibility (together with Poland and Sweden the worst among European healthcare systems) and an autocratic top-down management culture”. The UK has a poor record of treating cancer – OECD data shows that, out of 23 developed countries, the UK ranks 20th in bowel cancer 5-year survival rates. Funding increases would undoubtedly bring about minor improvements. Yet it does not hide the fact that the UK came 24th out of 30 in efficiency rankings of high-income states carried out by the OECD.
A new system is required. The French universal health care system (where they pay for health through national insurance-style ring fenced contributions) is both better-funded and puts patient choice, provider competition and mutualism front and centre. Healthcare is still provided universally and free at the point of delivery, and the state subsidizes those with chronic conditions and those without the means to pay for insurance.
The notion that a public monopoly directed by Whitehall bureaucrats (who need not have medical expertise) is the only way of running a health system is anachronistic. Just because you want the state to guarantee access to a service doesn’t mean the state has to be the actual provider – we want everyone to eat, but we don’t want to nationalise Tesco, Lidl and Aldi. We want everyone to be clothed, but we haven’t concluded that Next, Marks and Spencer and Primark should form a Whitehall administered conglomerate. The state can ensure free-at-the-point-of-use access without being the service provider.
Hopson says that “for the first time ever in NHS history, last year, all of the key targets were missed.” This should focus the collective mind to search for a solution beyond throwing more money at the problem. It is true that there has been a funding squeeze since 2010, but overall healthcare spending at the current time far exceeds the 6% of GDP that was allocated to the health service at the turn of the century.
The problem is not financial but systemic. We need to realise that plummeting temperatures will no longer correspond to plummeting results.
Photograph: ‘Lydia’ via Flickr