The following is part of a letter from Nicolas Dennis of Winchester, published in the London Review of Books:
“I see the Lansley Act of 2012 as the latest stage in a long process of fragmentation, marketisation, and erosion of professionalism (that started under Mrs. Thatcher). There are two effects of this process that I think should be more widely understood. The first is that before 1990 the NHS ran on goodwill, which has now been largely dissipated. The extra, usually uncounted, unpaid hours that people are willing to put in when they are public servants tend to disappear under a commercial or quasi-commercial regime. I suspect that politicians who thought that commercial pressures and competition would improve efficiency had no idea what they stood to lose, and probably thought the staff were, on average, taking what they could get away with rather than giving more than what they were paid for.
“Second, when providers are private or, like foundation trusts, quasi-commercial there is an incentive to increase activity. The more patients seen, the more investigations and operations performed, the better the bottom line. This makes for over-diagnosis, over-investigation, over-treatment, iatrionic disease and quackery. It is almost an invitation to profit from public gullibility.”
The NHS represented, in my youth, the high point of efforts to serve all the people, rather than offer shoddy service in return for profit. During all my time in America I have staunchly defended the British system against the bloated, bureaucratic system in America, which costs the nation almost twice as much per head as the maligned NHS. But observing the crowded waiting rooms, the long waiting lists and the lack of investment, even I have to admit I would rather be ill in America. The system used to be so good. Most people either don’t know or have forgotten how proud the nation was of the health system, and how it transformed the health of the working class, among other things. It is now all about accountants, balance sheets and administrators (just like the universities) – dismal, but the neo-whatever-they-are-these-days don’t care.
Epicureanism is partly about offering the greatest good for the greatest number of people. It also values public service with a smile, not a checkbook.
The biggest problem right now with the NHS is lack of funding. Successive governments have tried to compensate for the long-term underinvestment in the NHS with private money. But as New Labour’s PFI scandal has shown, there are unintended consequences of doing this- an enormous amount of debt being one of them. We spent less on healthcare than almost any other major developed country, despite having more wealth than a lot of them. The government ought to raise healthcare spending to the OECD average immediately, funded by a simplification of National Insurance, a slight NI raise, and a complete diversion of revenue raised from NI to the NHS- thus rebranding NI as an ‘NHS tax.’
But I completely agree with you. If the NHS had additional funding, it would be the world’s best healthcare system. In many ways, it already is. (http://www.commonwealthfund.org/publications/fund-reports/2014/jun/mirror-mirror). You don’t have to mess around worrying about which insurer to go for. All insurance-related bureaucracy is abolished. Everyone is covered. And of course, the NHS is almost universally popular. The Conservatives want to reform it along market lines, but even they don’t wish to abolish it. And in America, the states that have tried to implement some form of universal healthcare have the best system. (http://www.commonwealthfund.org/publications/fund-reports/2015/dec/aiming-higher-2015)