10 January 2023

The NHS is an anachronism – and Britain is waking up to the need for change


I won’t take it personally if you have no recollection of the publication in 1994 of ‘Towards a More Cooperative Society: Ideas on the Future of the British Labour Movement and Independent Health Care’. Let me just say that it was, for me, a big deal. It was the first time I’d put my head above the parapet on healthcare reform. And if I had not been so thick-skinned, it would have been the last.

The paper was a rather mild affair. It examined the history of co-operatives and other such mechanisms that working people had used to pay for healthcare before the NHS and suggested that there might, perhaps, be some useful lessons to learn.

The reaction was as if I had advocated the slaughter of every third child as a way of bringing down demand for care. I was called every name under the sun and told that my real agenda was to impose a US-style system. There were demands that I be thrown out of the Labour Party for daring to suggest that there might be other possible methods for delivering healthcare alongside the NHS.

This was despite the paper focusing on Benenden, the hospital in Kent and mutual fund set up in 1908 to serve union members, which has carried on doing just that ever since. It has over 800,000 such members today.

But until recently screaming anger has been the reaction to pretty much every serious suggestion for healthcare reform. No matter who makes the suggestion, what their motivation might be or what their plan actually involves, the default reaction of what one might call the ‘healthcare establishment’ and more voluble left wing politicians has been to traduce the motives and the ideas simply for daring to exist. The usual response is to yell ‘privatisation’ or ‘America’. It’s as if none of them have ever crossed the channel and noticed that other European countries have healthcare systems that offer superb treatment to everyone, and the poor are not ejected from hospital out of spite. There are, their arguments imply, only two possible systems: the NHS and the US, and if you don’t want the former you have to want the latter.

When Nigel Lawson famously said that the NHS was the closest thing the English had to a religion, he was wrong; it was more like a cult.

I speak from experience. In the 1990s and 2000s I worked in think tanks on health policy. I co-authored a series of papers with Prof Nick Bosanquet, doyen of health economists. They were calm, detailed examinations of specific problems within the NHS and proposed clear solutions. They were well received within government and the policy world. But because in other writings alongside these I was unambiguous about my view that the NHS was an anachronism in its current form, much of the more public reaction was deeply hostile – with the usual, ‘You want to turn the NHS into the US’ meme. (I should point out that it was still possible to have serious discussions in private, and under the Blair government I used to take delight in pointing out when I had been inside Number 10 to discuss my suggestions. It drove those who vilified me round the bend.)

But after three decades of banging away on this, first in think tanks and then as a journalist, I sense that something is changing. There seems to be a more open attitude to ideas. When former Chancellor Ken Clarke suggested that those who can afford to should pay towards GP visits and minor operations, he was not shouted down. There has instead been a perfectly reasonable argument as to whether his idea has any merit.

That is vital because now, more than ever, we need to be able to discuss reform – whether that is within the rough framework of the NHS or something very different. It is surely obvious to all but the most dogmatic defender of the existing model that the system itself is in trouble. Yes, the current crisis is in part about money and resources. But patently the issues run far deeper. At the most basic level, the NHS isn’t National – it varies by region. It isn’t a Health promoter – it’s an illness treatment facility. And it’s not a Service as we understand that today – you take what you are given. It was created in a long-gone era. We need a health system that is able to deliver for today and tomorrow, not least given the astonishing and wonderful advances in medicine.

I am a beneficiary of one these, a scientific miracle pill that gives me a daily highly targeted dose of chemotherapy which has, to be blunt, kept me alive. And yet while I would be handed it as a first line treatment if I was in Europe (and, yes, the US) it is only available here on the NHS as a last resort – years after I would have had to endure some of the most debilitating treatments. I am fortunate to have insurance which pays for it. But it is an outrage that others are denied it because we have such an anachronistic system.

Object to new ideas, yes; criticise, of course. Point out the problems. But do that in the spirit of discussion and debate, not as a means of closing them down.

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Stephen Pollard is Editor-at-large of the Jewish Chronicle.

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