News Analysis
BIRMINGHAM, England—Three letters still reign supreme over British politics: NHS.
Britain’s National Health Service (NHS) took pride of place at the 2012 London Olympics, and is often dubbed a “national religion.”
Labour’s recent campaign to “save our NHS” was about more than a crisis of funding and management. It appealed to a simmering national fear, blaming failures of the system on “creeping privatization” under Conservative reforms. Meanwhile, many experts dispute the “privatization” threat.
The NHS has been dogged by a growing number of crises.
This winter, the Red Cross stepped in at overcrowded hospitals where emergency patients were abandoned for hours on trolleys in corridors. The treatment delays resulted in two deaths. The Red Cross labeled the situation a “humanitarian crisis.”
It was the third winter in a row in which the seasonal rise in illnesses had tipped over already-teetering services.
Medical organizations talk of a staffing crisis, including a shortfall of 30,000 nurses, a high bed occupancy rate (up to 95 percent at the start of 2017), and a funding shortfall compared to other nations. The word “crisis” has shadowed the NHS since investigations revealed that between 400 and 1,200 patients had died needlessly at Stafford Hospital in northern England between 2005 and 2008.
Many health organizations have called for politicians to be honest about the funding shortfalls, but only a few outliers dare to suggest free-market solutions.
With the possible exception of the likes of Cuba and North Korea, experts say the NHS is the only nationally owned and run health care service in the world. Other nations have different universal health care arrangements, but these are run through nationally funded medical insurance schemes or other models that involve non-state organizations.
A Point of Pride
National pride in the NHS shows consistently in surveys, said Dan Wellings, former head of insight and feedback at NHS England and an expert on public perceptions of the NHS at health care think tank The King’s Fund.
“One poll in particular illustrates this by showing that for one in two people, the NHS is the thing that makes them proudest to be British,” said Wellings, referring to a 2014 Ipsos MORI poll.
Kristian Niemietz, head of health and social welfare at the Institute of Economic Affairs, a free-market think tank based in London, thinks the pride is misplaced.
“[The NHS] generally lags behind other comparable systems. Purely in terms of outcomes, it just isn’t a good health care system,” he said.
“The one thing that it is generally praised for—the fact that it’s universal—is absolutely nothing special. That’s true of virtually all health care systems in the world.”
“Privatization” is often misinterpreted as the abandonment of universal health care. A fully privatized system (that is, no government ownership of services) can still allow for universal care. But most Brits see this as antithetical to the NHS, and even small levels of private company involvement are viewed with suspicion.
Private companies have been contracted under the NHS for over a decade, accounting for about 5 percent of service costs. Together with other reforms, this has been dubbed as being part of a secret plan to privatize the NHS by the Conservatives—although experts point out that the amount of money spent on private contracts was similar under Labour.
“There is some harmless, maybe pointless, maybe technical reorganization of the NHS, then someone screams ‘privatization,’ and that kills off any chance of reform,” said Niemietz, adding that the health care industry suffers from groupthink, with the NHS dominating thinking due to its de facto monopoly.
Jason Parker, head of health care at U.K. accounting firm KPMG, agrees.
“Any baby steps that any government makes—whether it be into the role of the private sector, or insurance—get squashed quite quickly, and people aren’t brave enough to put forward the case.”
He said that health care professionals are skeptical of the the involvement of the private sector because they’ve never seen it in action. “It’s a chicken and egg situation.”
Resistance to Reform
Wellings said research shows that people clearly don’t want to contemplate changing the system to be like those in other countries. “The NHS model is deeply rooted in the national psyche. Respondents told us that this is because it is built on principles of fairness and equality.”
The birth of the NHS nearly 70 years ago is often painted as a triumph of the people over the establishment.
Niemietz said that narrative appears to have been retrofitted, and that the NHS was a pet political project.
Mathew Thomson, professor of history at the University of Warwick, is researching the cultural history of the NHS. He agrees the “heroic” narrative has been revised, but cautions against giving this too much weight.
He said health care before the NHS was more progressive than previously thought. “The NHS actually inherited the hospitals that were already there,” he said.
According to Thomson, national pride in the NHS didn’t exist in the post-war period, but grew in the 1980s in response to perceived threats. There was great public affection for doctors and nurses prior to the NHS; that emotional attachment may well have been transferred to the NHS, he said.
Wellings pointed out that doctors and nurses always top polls asking which professions are most trusted in society. “I think our faith in doctors and nurses probably reflects and partially explains our attachment to the NHS,” Wellings said.
