31 August 2023

If healthcare ‘privatisation’ killed people, most of Europe would be dead


The NHS used to be Britain’s ultimate sacred cow. It has always had a handful of critics, but their role in the debate used to be, as the writer Ed West puts it, ‘like that of the Middle Eastern wrestlers in WWF whose job was to be booed by the crowd when I was a kid.’

This has, at least tentatively, changed a bit over the past two years. You can now, at semi-regular intervals, find articles in mainstream newspapers which take on the cult around the NHS, and point out the superior performance of European social health insurance (SHI) systems (e.g. here, here and here). The Times is currently running an online poll on the question ‘Should the NHS be replaced by a European social insurance system?, and at the time of writing, about 4,000 people have voted yes. (And, no, that’s not just me clicking on the ‘Yes’ button 4,000 times.)

But at the same time, we also see the opposite reaction, namely, an aggressive doubling-down on NHS cultishness. There was a time when the NHS’s keenest supporters would have gone quiet when evidence of poor NHS performance emerged, hoping that nobody would notice. Failing that, they would have denied the evidence, calling it ‘unreliable’, ‘flawed’ or ‘cherry-picked’ without elaborating. Not anymore. We have reached a situation where, paradoxically, it is the NHS’s most committed fanboys who shout loudest about instances of NHS failure. This is because, in the upside-down fantasy world they have created for themselves, the more the NHS fails, the more this proves that the fanboys were right all along. 

This morning, the Labour Party released figures which show that in 2022, over 120,000 people have died while on an NHS waiting list. Within minutes, Twitter reached its verdict. 

Dr Dan Goyal, a medical consultant and activist, tweeted:

Similarly, Dr Andrew Meyerson, an A&E doctor and activist, posted:

And Harry Eccles, a clinical nurse specialist and activist, added:

As it happens: I have long made the case that the NHS causes tens of thousands of unnecessary deaths every year, a claim which I am basing on a simple comparison of survival rates for cancers, strokes and heart attacks between the UK and its better-performing continental peers such as Belgium and the Netherlands. But I will resist the temptation of claiming that the Labour Party’s figures prove me right, because they prove no such thing. They do, in fact, not prove much at all.

If you die while waiting for a knee operation or a hip replacement on the NHS, it is not your bad knee or your bad hip which killed you. The distinction between ‘dying with Covid’ and ‘dying of Covid’ was mostly a distraction, but the distinction between ‘dying while waiting’ and ‘dying because you are waiting’ is a meaningful one. The Labour Party’s own figures show that even before the recent explosion in waiting times, the number of people dying while on a waiting list was far from zero: it was about 60,000 in 2017. The number of people on waiting lists has almost doubled since then, so it is not too surprising that the number of people dying while on a waiting list has also roughly doubled. 

Nonetheless: we know that there have been well over 30,000 excess deaths (the number of deaths over and above what we would expect in a normal year) in 2022, and that excess mortality rates remain elevated. Other countries and health systems are not wholly immune to this either, but as is usually the case with healthcare-related figures, the UK does worse than most of its peers. 

So while we can argue about the exact figures, there can be no doubt that something is going badly wrong, and it would be very strange if the explosion in waiting times had nothing to do with this.

To blame ‘underfunding’ and ‘privatisation’, however, is courageous. In 2022, the UK spent 11.3% of GDP on healthcare – about the same as Austria, Switzerland, the Netherlands and Belgium, and well above the EU and the OECD average. Maybe that is still not enough, but it cannot be the reason why the NHS does so much worse than other systems. If the NHS is ‘underfunded’, then so is almost every healthcare system in the world. 

The NHS is also one of the least privatised and marketised health systems in the developed world. For example, the private sector only accounts for one tenth of the UK hospital sector, compared to 30% in Austria, 38% in the neoliberal laissez-faire hellhole of France, 60% in Germany, 72% in Belgium, and 100% in Norway and the Netherlands. If it really were ‘the price of privatisation that people will die’, most of the population of Europe would be dead. 

As the NHS budget and workforce continue to grow, and NHS performance continues to lag, the system’s failings will become ever more obvious and harder to deny. I expect that, against this backdrop, the hysteria around imaginary ‘privatisation’ plans will be dialled up a notch, and the defensiveness around the health service will become even shriller and more aggressive. 

But hopefully, this will also lead to more people realising that something is not quite right. 

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Kristian Niemietz is Head of Political Economy at the Institute of Economic Affairs

Columns are the author's own opinion and do not necessarily reflect the views of CapX.