It’s Time for an Honest Debate About the Provision of Healthcare

By MARCUS STEAD

We need to face up to reality about the National Health Service. For too long, it has been politically taboo to question whether the current model is either the best way of providing healthcare, or its sustainability in the long term.

The Labour Party likes to portray Aneurin Bevan as the founder of the NHS. This is not the case. In fact, it was a key recommendation of the Beveridge Report of 1942, in which William Beveridge, a Liberal economist, outlined social reforms that were to be brought in at the end of World War II.

Both the Conservative and Labour parties agreed in principle to implement the report’s recommendations, regardless of which party won the first general election after the war (it came in 1945, and was won by Labour).

Beveridge’s vision was of a National Health Service run through local health centres and regional hospital administrations. In other words, they were to be non-political and free from government interference. But in the years immediately after 1945, Labour’s Minister of Health, Aneurin Bevan, had other ideas.

Bevan, a temperamental, undiplomatic, extreme left winger, loathed by many inside the Labour Party, fought hard in Cabinet to abandon Beveridge’s vision in favour of a centralised structure of 14 regional boards appointed by the Minister of Health and local management committees.

From that moment onwards, the NHS became a political football, and it has remained so ever since. Bevan, knowing full well the implications of the seed he was sowing, didn’t allow facts and evidence to get in the way of his ideological dogma. Sir Harold Webbe, the Conservative leader on London County Council, was unhappy about local government’s role in the NHS being removed, and said of Bevan, “He is so full of his own importance that he is prepared to pit his knowledge against the accumulated experience of this council, which is to be butchered to make a Welshman’s holiday.”

Yet even Beveridge’s vision for an NHS contained three major assumptions that sounded quite reasonable at the time, but subsequently turned out to be utterly incorrect:

1. As people became healthier, demand on the NHS would decrease.
2. The demographics of society would remain roughly the same.
3. The NHS could be paid for from ‘the stamp’, now known as National Insurance.

The reality has been utterly different. Huge medical advances in the last 60 years have resulted in significantly increased life expectancy, albeit with the assistance of ongoing care and drugs, which come at a price.

With the exception of the Callaghan government of 1976-79, all administrations have overseen vast increases in real-terms spending on the NHS, as demographics shifted, demand increased, and medical advances continued. By the late 1980s, National Insurance could just about cover pensions and contributory benefits, with the occasional bit of help from general taxation, but it was certainly no longer in a position to fund the NHS.

There is some evidence that Margaret Thatcher understood the magnitude of the problem as long ago as the early 1980s, but she was advised not to handle the ‘hot potato’.

The time has come to end the mawkish obsession with the NHS model, which was epitomised at the 2012 Olympic opening ceremony by the sight of nurses jumping up and down on beds. Britain’s cancer and stroke survival rates are significantly down on where they should be for an apparently rich country, and there is a lack of choice on the part of the patient.

It is easy to see why the Labour Party is so ideologically attached to the NHS. It frequently misleads people into believing it is a Labour creation, and is one of very few things in this country that can in any way, shape or form be described as a Labour success story.

The quasi-religious reverence with which the Labour Party treats the NHS, and the way in which it tries to make bogeymen of anyone who questions it in any way, is holding back a full, honest and frank debate about how we provide sustainable healthcare for the next 50 years.

When they hear any form of criticism of the NHS, their default position is always to make crude comparisons with the system in the USA, one they rarely know very much about, and are quick to point to horror stories within, while conveniently ignoring the numerous deaths in the NHS due to poor hygiene, lengthy waiting times and medical negligence. Doctors and nurses themselves are treated as saints to be revered, rather than tax-funded employees who deserve praise and respect when they do well, but should not be above criticism when they fall short of certain standards.

It is as though no other countries or healthcare systems exist elsewhere in the world. Why can’t we try to learn lessons from Singapore, which from a very low starting point in the 1960s, has managed to create and sustain one of the very best health systems anywhere on earth? Or what about continental Europe, where many countries operate with a mix of public and private healthcare, with compulsory insurance schemes using various models?

This debate should have begun at least 20 years ago, but there are signs that we are approaching the point where the current NHS system is unsustainable. Sooner or later, we will have to face up to this impending reality. Is it not better to do so while the hospitals and GP surgeries are just about working?