27 April 2022

Does anyone still seriously believe the NHS is the ‘envy of the world’?


Over the last few years the phrase ‘envy of the world’ has gone from an annoying cliche about the NHS to an epithet most often employed ironically by its detractors.

Today’s report from the thinktank Civitas, authored by former CPS director Tim Knox, makes for a difficult read for anyone who still honestly thinks ours is the greatest health system the world has ever seen. 

Knox’s report is all the more striking for how little editorialising is involved. Rather, he has simply taken OECD health data across various criteria and seen how well the NHS does compared to similar countries’ health systems. 

The answer is, unfortunately, not very well at all.  

On life expectancy we are 17th out of 19 countries; on deaths from treatable disease we are 15th out of 16. On both strokes and heart attacks, the NHS comes ninth out of nine (NB: the number of comparator countries varies because of availability of data).

The record on cancer treatment is abysmal: across five different kinds of cancer, the UK came 16th out of 18 countries surveyed.

Perhaps most chastening of all, this report uses data from 2019, so none of the deleterious effects of the pandemic, or the enormous backlog for various kinds of treatment, will show in the data. This is essentially a ‘pandemic notwithstanding’ NHS – the real one is even worse. 

Has this nasty rightwinger simply cherry-picked the data to make Our NHS look worse than it is? Again, no. Knox’s methodology is actually the same as for a 2018 BBC-commissioned report authored by the not notably conservative Health Foundation, the Institute for Fiscal Studies, the King’s Fund and the Nuffield Trust.

Ah, the faithful reply, but this is simply a matter of those bastard Tories chronically underfunding the service, probably as part of their evil plan to privatise it.

That argument simply doesn’t hold water. We may not spend as much as some countries, but the 2019 spend of 10.2% of GDP matches the average of countries’ whose outcomes are better than ours. 

Nor are these poor outcomes the price we pay for a uniquely equitable approach to providing healthcare. The universality that is at the core of the NHS religion is a fine thing – but it’s also par for the course in virtually every other developed country: Japan, France, Canada, Italy, Sweden, Australia…all offer just the same level of comprehensive care as Our NHS.

Indeed, the reason the NHS’ most fervent defenders love citing the awful US system is precisely because it stands out like a sore thumb among Western health systems.

As Tim notes in the foreword to the report, the latest British Social Attitudes suggests public patience with the health service is at rock bottom. That’s no great surprise when literally millions of people are on a waiting list, some of them with vital treatment delayed for an inordinate length of time.

It’s nothing to cheer that people are so unhappy with such a crucial public service. But at the very least it might create the political space to finally have an honest conversation about where the service is doing well and where it is falling down – one which isn’t based on inane myths about the Government trying to ‘sell off’ the service, or claims that any criticism is tantamount to an attack on hardworking frontline staff.

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John Ashmore is Editor of CapX.