Anecdotes aren’t data (as the apparently oft-misquoted saying goes), but over the past 14 years the two paint a depressingly similar picture of Britain’s National Health Service (NHS).
A friend recently diagnosed with breast cancer was told she needed surgery to remove a small tumour. It took months for her general practitioner to refer her for testing after she initially complained of unexplained weight loss and later pain. The operation was scheduled and cancelled several times. There were junior doctor strikes. It was a weekend. The right equipment wasn’t in place. She heard various explanations.
Unwilling to wait further, she used her savings to fund the surgery privately—by the same consultant (as surgeons are known in the UK) who was scheduled to operate in the NHS hospital. By then, some 10 months had passed since she first called her GP and the cancer had spread to her lymph nodes, requiring more extensive surgery. Her prognosis is uncertain.
The story of the NHS over the past 14 years might be called ‘The Big Wait’ or even ‘The Big Short’ (if that title weren’t already taken). More than 7.5 million people are awaiting treatment, up from an already high 4.43 million before the pandemic. The service is short of doctors, nurses, beds, radiographers, scanners and more. There are hospitals in such a state of disrepair that they are unsafe. Many British doctors are opting to practice abroad or leaving the state system.
The Big Wait means higher costs, in terms of festering health problems, the mental toll of uncertainty and the productivity loss from lives on hold. It has contributed to a stark rise in the number of people who are economically inactive due to ill health and an uptick in excess deaths.
GP offices in Britain are often understaffed; appointments can take weeks to get despite government attempts to reduce wait times. More and more Britons, like my friend, are opting for private care if they can afford it, resulting in what is effectively a two-tiered health system.
Underinvestment is partly to blame. Average health spending in the UK between 2010, when the Tories returned to government, and 2019, before the pandemic, was 18% below the EU average. The UK would have had to spend £40 billion ($51 billion) more each year to match French levels of health-care spending and £73 billion more to equal Germany. Although the Tories have increased funding more recently, average real terms growth is still below historical trends. And the problems go far beyond financing.
The UK model suffers from several flaws that have been compounded by policy decisions over the past 14 years, but also structural changes such as an ageing population, people living longer lives and more expensive treatments. Healthcare suffers from a curious combination of over-centralized decision-making and silos of care that make it slow to adopt innovation and adapt to patient needs.
This isn’t an indictment of universality in healthcare. There is no perfect system; the US stands out among advanced countries for not having universal care. Other major-economy health systems have problems but report better outcomes in most areas.
There have been some efforts to address some of the flaws, but they don’t go far enough. And none fix the albatross around the NHS’s neck: the lack of a comprehensive system of social care. That has meant the elderly and those with chronic needs are often held in hospitals, which harms their outcomes and reduces availability for those with acute illnesses. The Tories’ unkept promises to fix social care will likely be one among many party epitaphs.
The Labour party’s outspoken shadow health secretary Wes Streeting has rightly said the NHS is a service not a shrine. He has promised to focus on efficiency and outcomes, overcoming the kind of institutional defensiveness that has been exposed most recently by a damning report into a decades-old contaminated blood scandal. He seems determined to place more focus on preventive care and community care.
Labour has proposed to halve wait times exceeding 18 weeks within five years of taking office. And yet such plans, and Streeting’s broader goals, take resources—likely in the form of either higher taxes or the introduction of charges for some basic services, along with structural change to the way the NHS operates. So far, nothing suggests that degree of boldness.
The National Health Service is often said to be the closest thing the UK has to a national religion. It performed admirably during the pandemic, but Britons are losing faith for good reason. If the Labour Party hopes to restore confidence and deliver better results, it would have to do more than tinker. ©bloomberg