“Facts are stubborn things; and whatever may be our wishes, our inclinations, or the dictates of our passions, they cannot alter the state of facts and evidence.” So said John Adams, the second President of the United States. The quote is old, but the words are timeless.
In today’s political debate, in America, in the UK, all over the world, indeed, facts can be hard to ascertain. They can be obscured. The inclinations and passions of which President Adams spoke can be presented as fact in order to meet the political objectives of the obscurer.
There is perhaps no finer example of inclination and passion obscuring fact than on the matter of the UK’s NHS. It is a service which, in theory, differs across the four nations of the UK but, in practice, has the same structure, with broadly the same inputs, and broadly the same outputs.
The NHS unites political debate more than anything else. More than the BBC. More than the monarchy. More than any British tradition you can name.
Politicians from all across the spectrum will place more money for “our NHS” atop their manifesto pledges come election time. They will adorn their Twitter feeds with #ThankYouNHS and emblazon their Facebook pages with selfies at vaccination centres or, if their PR teams can persuade somebody in hospital management, a photo with some nurses on a ward.
There is no political leader in any part of the UK who questions the NHS’s structure or performance. Not one. And, of course, the public agrees. Over two-thirds of people think the government should spend more on the NHS, according to YouGov, the pollster. More people think healthcare is the most important issue facing the country than the combined total of those who think it is either education or the economy. And less than one-in-five people think that the NHS provides a poorer service than the health services of European countries.
The NHS is, without question, the greatest public relations campaign in history. But, sadly, these are the dictates of our passions. They cannot alter the state of facts and evidence.
And those facts, and that evidence, are there for anyone inclined to look. They are stubbornly present, provided by the Organisation for Economic Cooperation and Development (OECD).
The first and most obvious fact, often mischievously obscured by politicians in the UK, is that the NHS is far from unique in providing universal access to taxpayer-funded health provision. This is the case all over Europe and the world - 98 per cent of the OECD population has access to core health services, and the primary reason for the two per cent drop-off is the lack of universal coverage in the United States.
The second fact, so often misrepresented here, is that the UK spends well above average on its NHS. We spend over ten per cent of our GDP on healthcare; more than Denmark and Finland, more than Portugal and Spain, more than Australia and New Zealand.
For every man, woman and child in the country, we spend over £3,300, almost £370 more than the average.
So often in our politics, the mark of common decency, of acceptability, or electability, is to promise to spend more on the NHS. By encouraging this behaviour in our politicians, reader, you are asking to be lied to. We should be demanding not that they spend more, but that they spend better, on a service restructured along a European model.
Here’s why. The average number of hospital beds across OECD countries is 4.4 per 1,000 people. In Germany it is 7.9; in France 5.8. In the UK it is 2.5.
Across the OECD, there are 3.6 doctors per 1,000 people. 5.3 in Portugal and 4.4 in Spain. 5 in Norway and 4.3 in Sweden. In the UK, there are 3, just behind Costa Rica. That situation looks highly unlikely to improve, for the UK has just over 13 medical graduates per 100,000 population, sandwiched between Turkey and Colombia, beneath the OECD average. The Republic of Ireland has almost 25.
The data for the nursing population is scarcely better. Top performing countries have three times the number of nursing graduates of the UK; across the Irish Sea, they have 50 per cent more qualified nurses.
Outcomes, including survival from cancer, stroke and heart disease, hover around the OECD average. Sometimes above, sometimes below. Never leading. Never the envy of the world. Given the relative lack of staff, beds and equipment, this averageness is, in fact, a testament to the efficiency of the NHS.
One of the few sets of OECD data in which the UK sits well above the average, deeply ironically, is in satisfaction, with three quarters of the population satisfied.
We should expect more. Our national psyche, encouraged over decades by politicians of all parties, encourages a sense of gratitude over expectation. Our debate is deliberately skewed to persuade us that we should be grateful to have the NHS. Skewed to make us believe that we are uniquely privileged. Our politicians, along with the medical establishment, even go to the lengths of maintaining the myth that the NHS is ‘free’.
This is the point at which, in a post-Covid environment, a new debate on the NHS should begin. Firstly, we should accept and understand that the service is no more free than the coffee in your mug. The average earner, on £25,000 per year, pays around £5,000 in tax. The government spends at least £1,000 of that on the NHS; this is money paid from your income, reader, towards your healthcare. It is not free.
Secondly, we should, all of us, move beyond our expectation that the job of the NHS is to catch us when we fall. Our health is, primarily, our responsibility, and it is the nature of the debate on the NHS that has gradually encouraged us to outsource this responsibility to the NHS. Smoking rates are at the OECD average, but alcohol consumption is above it, and obesity rates are significantly so.
Thirdly, we should simply open our eyes. The NHS is not special. If the rest of the rich world wanted an NHS, they would have one. That they do not tells its own story.
Andy Maciver is Director of Message Matters
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