During its 75-year history, the National Health Service has sometimes been described as the “envy of the world” or as the United Kingdom’s “national religion”. Whether or not this was ever true, it certainly is not now.
Britons now have the worst access to healthcare in Europe. Over the past year, one in six adults in the UK has had a pressing need for medical examination or treatment but has been unable to receive it. The number of patients in England waiting more than 12 hours in A&E to be admitted or discharged has risen 355 per cent since last November. The problem is as acute in Scotland – where control of the health service is devolved – as it is in England.
As the crisis intensifies, bleak stories emerge: “ill children sleep on waiting-room chairs; a 92-year-old woman ‘asked to die’ during 33 hours spent in a corridor; an A&E patient waited for four days on a gurney”, as our Britain editor, Anoosh Chakelian, writes on page 21. The Royal College of Emergency Medicine estimates that up to 500 patients die each week because of extreme service delays.
The temptation for government ministers is to present this crisis as unavoidable: the inevitable consequence of the backlogs and weakened immune systems created by the Covid pandemic and the lockdowns it necessitated. But this is to absolve themselves of responsibility for a succession of political choices.
Since returning to power in 2010, the Conservatives have promoted the comforting myth that the NHS has been protected from austerity. In reality, the service has endured the tightest spending settlement in its history. Since 1950, health expenditure has grown at an average annual rate of 4 per cent, but from 2009/10 to 2018/19 it increased by just 1.5 per cent a year. The UK spends 39 per cent less per person on healthcare than Germany and 21 per cent less per person than France. An ageing but not necessarily healthier population, the rising cost of drugs and technology, and the growth of chronic conditions, such as obesity and diabetes, means the NHS is being asked to do more with less.
The egregious cuts to social care – which Chancellor Jeremy Hunt, a former health secretary, last year called a “silent killer” in an interview with the New Statesman – only deepened the crisis. Hospitals have been left unable to discharge tens of thousands of patients for want of care home places. Rather than ending this absurdity, the government has been content for the NHS to act as a provider of last resort. Numerous patients are ending up in A&E, and on wards, whose care should have been delivered in the community.
The consistent fall in GP numbers – based on the government’s own figures, England is now short of 8,000 doctors in general practice – means that upwards of 12,000 patients are being referred to the emergency services each day by NHS 111.
What is to be done? Too often, politicians and commentators present a false choice between higher funding and greater reform. The reality is that the NHS needs both. Without higher funding, the health service will not be able to treat an ageing population or recruit the staff it needs. The ongoing nurses’ strikes are no surprise when their pay is worth 2 per cent less in real terms than it was in 2010. Rather than imposing draconian anti-strike legislation, the Sunak government should reach a fair settlement with them and other public sector workers.
Support for the principle of a free health service funded from general taxation endures among most voters. Rather than forcing those on low incomes to pay more, however, the government needs a more resilient model of taxation. The next Labour government should consider increased taxation of wealth – property, land, inheritance and other so-called static assets. Higher funding must not, however, hide a deeper truth: Britain is a sick society. It has some of the highest rates of mental illness, obesity and drug use in Europe. This, in turn, reflects dangerous levels of poverty across generations and among children.
No public health service, however well-funded, can adequately compensate for this. Without early intervention through policy (the ban on smoking in public areas was a great success) and more ambitious public health measures, the UK will remain the sick man of Europe. As well as promising a better NHS, politicians need to offer something else: a better, more decent society.
This article appears in the 11 Jan 2023 issue of the New Statesman, Burning down the House of Windsor