Five years ago, Britain’s best-loved institutions were at the centre of Danny Boyle’s Olympic opening ceremony. The NHS took pride of place alongside James Bond, the Queen and EastEnders: as the rest of the world watched with bemusement, the stadium in Stratford was transformed into a 1950s-style hospital in a celebration of the state-funded health service the nation holds so dear.
We have to go back 70 years to the pre-NHS world to understand why the public regards the health service not just as an everyday medical reality but as a cherished national institution. Before 1948, getting sick for many meant not just the pain and worry of illness but the knowledge that their lack of means meant treatable conditions could prove terminal.
Across much of the globe – including the world’s richest country, the United States – that shocking state of affairs remains a reality. But here in the UK, the founding principle of the NHS – that treatment should be available free at the point of delivery according to need, regardless of ability to pay – remains central to the way healthcare is provided. At the same time – confounding the ideological naysayers who claim that a state-funded system is doomed to fail – the NHS is ranked top in a Commonwealth Fund survey of 11 international health systems, including those in the US, Germany, France and Sweden. The patriotic pride the NHS inspires in many is not simply sentimental fancy.
That certainly doesn’t make the NHS perfect. It remains too wedded to a model based on fixing the sick rather than helping people to live healthier lives in their communities. That’s increasingly problematic in an ageing society in which people live for longer, but with more long-term conditions such as diabetes and dementia.
Its resources have always been finite, which means difficult rationing decisions are made every day – not always transparently – and regional inequalities abound. There are stark variations in the quality of care that cannot be explained away by a lack of funding: the very worst of this is represented by the abominable care at Mid Staffs. And significant challenges lie ahead: a looming workforce shortage, and the problem of how to integrate personal care and healthcare when the two systems could not be funded more differently. These would be daunting in an organisation of any size, let alone the world’s fifth-largest employer. Overall, though, the story of the NHS is one of remarkable success.
But its current predicament is completely unprecedented. Last week, NHS England took the extraordinary step of extending the ban on all non-urgent surgery until the end of January. The cruel reality of this is yet more people being told their pain-relieving operations are being postponed. It is also entirely self-defeating: patients are being left untreated until their painful but non-critical conditions become increasingly life-threatening, costing the NHS more in the long run.
The scale of the crisis is not just without precedent; it was entirely predictable. The warning lights have been blinking furiously for years: targets increasingly missed; patients waiting on trolleys in corridors for hours; the steady spread of rationing using arbitrary and unethical criteria; and bed occupancy rates consistently above the levels that permit safe care.
The prime minister last week apologised to patients facing more cancellations. Apology unaccepted: this crisis has arisen directly out of the decisions taken by Conservative governments since 2010.
Put simply, funding for the English NHS is not keeping pace with what’s required to maintain existing standards of care in the context of a growing and ageing population. Moreover, government funding for social care has been cut: a quarter fewer older people are getting state help with the costs of their care than five years ago, despite increasing levels of need. Instead of ensuring that frail older people have the support they need to carry out tasks like washing and eating, the system is increasingly leaving them until they break their hip, or become malnourished, then consigning them to spend the rest of their lives on a hospital ward.
Some are disingenuously using the crisis to argue that a free NHS is unsustainable, and we need to move to a system of private insurance. But to put things in context, the UK spends less as a percentage of GDP than the EU average on health and personal care; and far less per head than the US. It performs very well on international measures of efficiency. Moreover, it commands huge levels of cross-generational public support: 77% of the public “believe the NHS is crucial to British society and we must do everything we can to maintain it”, and 90% support its founding principles.
Scrapping its founding Bevanite principles is entirely the wrong prescription. Yes, the NHS needs long-term reform but within those broad parameters. If anything, there is a strong case for extending its model of free care according to need to social care, rather than importing the principles of social care – access to a two-tier system dependent on what people can afford to pay – into the NHS.
But no organisation can enact stretching reforms while it is under such immediate funding pressures. Indeed, starving it of cash makes successful long-term reform a more distant prospect, with knock-on effects on staff morale, workforce shortages and unsafe care. It takes the NHS even further away from the preventative health service it needs to become, and closer to an emergency safety net that leaves people to get increasingly sicker before it will treat them, undermining the postwar promise of 1948.
There are a growing number of cynics who accuse the Conservative government of deliberately starving the NHS of cash in order to pave the way for its dismantling. Ministers strongly contest this, but if they continue to take no action, their protests will ring increasingly hollow. This is a government that has – during a period of self-imposed austerity – delivered more than £20bn a year of income tax cuts since 2010, the benefits of which have disproportionately gone to better-off families.
Polling indicates that two-thirds of the public are willing to pay more taxes in order to maintain the level of spending needed on the health service, with only 10% willing to countenance a reduction in the level of care provided by the NHS. Gordon Brown’s 2002 1p increase on national insurance to fund the NHS was supported by an extraordinary 76% of voters when it was introduced at the time. A tax increase to fund the NHS and social care would easily command the support of the opposition. There are literally no excuses left for the government’s failure to act. It should combine the national health and social care budgets; and use the proceeds from a popular income tax rise and increased wealth taxes on affluent baby boomers to plug the NHS gap and extend free personal care to all.
It’s no exaggeration to say that the government’s lack of action is setting us down a path towards a pre-1948 world, in which those who can afford private healthcare opt out, and those without means will be consigned to whatever substandard level of care is left. Prime minister: an apology isn’t enough. When are you going to do something about it?
guardian.co.uk © Guardian News & Media Limited 2010