The NHS – a Political Football for Ever

The NHS is the fifth largest employer in the world. It is, easily, the largest employer in Europe. It gets through, at the last count, 116.4 billion pounds of taxpayers’ money a year. And yet, year after year, month after month, day after day, we have been told for decades by opposition politicians (it doesn’t matter which party) that the government of the day is destroying the NHS because it is not putting enough money into it.

The trouble is, of course, that no health service can ever be perfect. In Britain, because health is provided by the state, all imperfections are blamed on politicians (partly because other politicians see political advantage in blaming the other side). In most other countries, which have insurance based health services, governments can’t be blamed for shortcomings. But we are stuck with a health service which will, for ever, have all its failings blamed on governments.

As it happens, even though, for many years, Conservative governments have ploughed more money in real terms into the NHS than have Labour governments, it is the Tories who come off worse in this political football match, and they always will. That is because there is a general assumption that Conservatives don’t like the NHS and are keen to privatise it. My own view is that there would be a lot to be said for moving to an insurance based system (with masses of safeguards), but I know full well that no Tory government would ever dare do anything so radical. Conservative governments will continue to put more money into the NHS than Labour governments will (I am charitably assuming there may one day be another Labour government). That is for the simple reason that people assume Labour is keen on the NHS. That enables Labour to be meaner than the Tories.

But one of the deeply unsatisfactory results of health care being seen as a major political issue is that the magnificent work of our hospitals and doctors is constantly denigrated. Oppositions (of both parties) always say that the NHS is in crisis, that basic health care is being denied to patients because evil governments are trying to save money. But that simply isn’t true. I know, from my own experience, that referrals to hospital specialists are now, though they weren’t a few years ago, acted on immediately. I know that MRI scans, for which there used to be waiting lists of six months or more, are now done within days. I know that important operations are now performed within days or weeks rather than months or years.

The NHS of today is immeasurably better than the NHS of fifteen years ago. But, of course, there are still major problems, problems which have very little to do with politicians and nothing to do with money.

Administration in hospitals is, generally, dire. Because I foolishly contracted three different cancers about a year ago I have found myself having to go to hospital rather a lot (mostly as an out-patient but sometimes as an in-patient). Whenever I see a consultant he writes a letter to my GP (with copy to me). The letter always says, at the bottom, “approved electronically to save time”. Almost by magic, it is posted exactly a month after it was written. Appointment letters frequently arrive many days after the appointment. There is no excuse for that sort of thing. I am sure it has nothing to do with money but a lot to do with administrative staff failing to understand that they are meant to play a part in curing illnesses.

And then there is the major problem of patients being kept on trolleys in A and E when they ought to be admitted to wards. This, I think, is what led to the British Red Cross declaring a “humanitarian crisis”. That, as we all know, is partly due to “bed-clogging” by patients who ought to go home but for whom care at home has not been arranged. Politicians probably could do something about that, though it would need local authority employees to play along and that might be difficult to achieve.

But I can tell you that bed-clogging is not the only problem. I was interested, when I was in hospital for major surgery and had to be there for a while, to see that, every day, patients would be discharged, their beds made up again and no one else would appear to fill the beds for many hours. It gradually dawned on me that the nursing staff were telling the bed allocation people that there were still no beds available, even though there plainly were. It was understandable, I suppose. New patients require quite a bit of work. Better, by far, to wait for the next nursing shift to take over before revealing that beds were free.

I was a very minor victim of this myself, a few weeks after my discharge (which was delayed by about five hours because the pharmacy took that long to produce my medication), I developed an infection. Rather tiresomely, but quite correctly, my GP insisted that I should go straight to A and E. I was treated very well there. I was allowed to bypass the usual five hour wait and taken through to a cubicle. A urology senior registrar came to see me within a quarter of an hour. He said I would have to be admitted for intravenous antibiotics. I would be taken up to the ward as soon as a bed was available. For the next few hours, lying on my trolley, I pictured the scene in the ward. I think I got it about right. I could see, in my mind, several empty beds and a nurse on the telephone assuring whoever was asking that there were no free beds. Then, just as the night shift was due to take over, quite miraculously, the message came that a bed was at last free. I was taken up to the ward and amused to notice at least six empty beds.

These are mere anecdotes. But the British Red Cross is also relying on anecdotes. We both agree that there is a problem. The difference between us is that the British Red Cross thinks all will be all right if another billion or so pounds are given to the NHS, while I think that, however much more money is provided, the same problems will continue.

I have no solution to offer. We are stuck with the NHS. It is a gigantic organisation. It has all the problems any organisation of its size (or even a quarter of its size) is bound to have. But it is enormously fortunate in having medical and surgical staff who just get on with the job, and do it exceptionally well. Next time you are tempted to use the NHS as a political football, please remember the massive good it does.

Charles

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12 thoughts on “The NHS – a Political Football for Ever

  1. It is probably the largest in the world, though Indian Railways and the Russian Army are close. As for the NHS going downhill, it was meant to cater to the UK, not half of Poland, Slovakia, Jamaica. Try going abroad with no health insurance and see what happens.

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  2. The NHS is a mixed bag. Some of the professional staff are excellent there are others who are ok and then there are some leave much to be desired administration is a case in point and everyone has horror tales of the lack of expertise evident within any place but these are isolated (and fixable) difficulties or problematical is finance. Plainly those who made decisions on behalf of NHS authorities in the past have made gigantic Boo Boo’s over PFI and the tab for that will take decades to pay off. The recent utterance by the Red Cross is a fifferent issue entirely – if the NHS is called a humanitarian crisis what term do we apply to places like Syria or Iraq or any of the other troubled places in the world. it would make sense to be a little more careful with language.
    My thought on contributions based or insurance managed health system are that’s in an administrative sense this would be a fairly inefficient and possibly easy to game system. My preference is still for free at the point of delivery and to build the system from there.

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    • Interesting, thank you. I see, elsewhere, that the British Red Cross is run by a prominent Labour official. So it may be that the “humanitarian crisis” stuff was just a party political point.

      Charles

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      • One is reminded of the decision by labour politicians of yesteryear to turn a blind eye to the potential for an immigrantion crisis – back in the early 2000s – in the knowledge that this would change the demographics of our nation. For years Labour denied there was a problem in the border controls. I suppose it is very tempting to connect the two uncontrolled immigration and humanitarian crisis. Some labour lovie must have wetted him/herself at the thought of being the first to say this – then again this is all part of the long Labour suicide note.

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  3. I am curious by your line “In most other countries, which have insurance based health services, governments can’t be blamed for shortcomings.” I understand most of the civilised world has single-payer state run healthcare of various permutations. In fact the only insurance-based system I can think of is that in America and what with Medicaid and the Affordable Care Act it’s about as politicised as it gets.

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    • I fear you are wrong, Colin. It is true that Italy, Spain and the Scandinavian countries have single-payer systems, but I can’t think of anywhere else in the free world that does (though I am sure you will find one somewhere). Most western countries have a combination of insurance and state funding. That, I suppose, explains why the NHS is a bigger employer, by far, than any other health system in the world.

      Charles

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      • Interesting. yes, a swift glance at the French and German systems indicate they are not run on the same lines as the NHS. They provide Universal health care but use a more complex arrangement of funding.

        The important thing, which both appear to maintain, is there should be no connection between level of contribution, whether through tax via the exchequer or insurance paid direct, and the degree and quality of healthcare received.

        Wikipedia offers high praise for the German system.

        I don’t regard the NHS as a sacred cow by an means. Provided the system remains free at the point of use and provides an excellent service the exact funding mechanism seems neither here nor there.

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