NHS: There is a way to save our crumbling health service. Here it is

In Britain, we have no national day to gather around (and even in the nations the days of St George and St Andrew and the like are barely noticed). The King’s birthday is, I suppose, as close as it comes, but I would confess that I don’t even know when it is and it certainly doesn’t call for hot dogs.

In substitution, on Wednesday we had a birthday party for the National Health Service, which turned 75 years old, complete with a full service at Westminster Abbey and commemorations across the country.

I find the juxtaposition rather worrying. The French do not have their troubles to seek this summer, and the Americans are in a political death spiral, but every July they celebrate something deeply meaningful and real; something around which divided people can unite.

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We, on the other hand, celebrate what in essence is a myth. It has been said that the NHS is Britain’s national religion, but in fact it is our national delusion. We are lauding hysterical praise on a system which, across all four subsystems of the UK, is simultaneously the best funded and worst performing it has ever been.

Around eight million people, that’s something in the order of one-in-eight of the entire population, were sitting watching this celebration of the NHS while on an NHS waiting list. Some of them will die as a result. Many will live a shorter life. Most will be limited in what they can achieve. There is something deeply rotten going on here.

There are facts in this matter. The OECD tells us that the NHS receives comparatively more funding (just over ten per cent of GDP) than the average (which sits at under nine per cent). We may wish to provide more funding, but it is demonstrably wrong to label the NHS ‘underfunded’.

And yet capacity, in a word, is the NHS’s unique problem. We have significantly fewer doctors and nurses per head than our European neighbours, significantly less equipment, and in particular a dismally small number of beds – less than half the OECD average and only around one-third of the aforementioned French.

Last month, the King’s Fund issued a report which confirmed these statistical facts and identified capacity as the NHS’s key problem, but inexplicably concluded that attempting to copy European systems would be the wrong conclusion to draw.

It’s rather like telling an immuno-suppressed alcoholic with high blood pressure, heart disease and liver cancer that reducing his alcohol consumption would be the wrong conclusion to draw from his set of facts. On the contrary, it would of course be precisely the correct conclusion to draw.

We can hold as many birthday parties and pour as much money into the NHS as we want, but unless we change the system the outcomes will continue to worsen, because it has stood still for 75 years while the world around it has moved on.

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There is no fait accompli here. We can have high quality, universal access, state funded healthcare, free at the point of need, and if we wish we can call it the NHS. Names don’t matter, but systems do, and there are two shibboleths we must remove before we can create a system which will work.

The first is in the supply of healthcare. The primary reason for our capacity problem is that the supply of healthcare is nationally planned (the clue is in the name of the NHS). Although we have regional boards, capacity is based on predicted national need, and what’s more it is based on a ‘run hot’ model where beds are intended to be full, scanners are intended to be in use and doctors and nurses are intended to be run off their feet.

The intention is maximum efficiency, but the outcome is maximum waiting lists and waiting times when demand goes up, as well as legitimately unhappy, stressed and disillusioned doctors and nurses.

A regionalised supply model with a variety of public and private providers, allowing patients to choose where to use their state funding, would dramatically increase capacity, as well as standards.

There are a handful of areas of specialist care which would need to be excluded because they are best provided on a national level, such as the Queen Elizabeth National Spinal Unit, but for the majority of elective surgery, for instance, a model of decentralised supply (ie care) with centralised demand (ie money) would deliver a European-level output to match our European-level input.

Coupled with embracing digitisation and medical technology, this would release the funding required to perform nothing less than a hiring spree for more doctors and nurses.

The second shibboleth is in the funding, not just of healthcare but of old-age care, too. Our care cannot continue to be funded by taxpayer pounds alone. Demographics tell their own story here; a reducing proportion of taxpayers cannot continue to fund the healthcare of an increasing and ageing proportion of non-taxpayers, and we are debasing ourselves by pretending otherwise.

As a nation, we accepted that workplace pensions were needed to supplement what the taxpayer could afford to provide as a state pension. We now also need to accept that workplace healthcare payments, for those who can, will be needed to supplement what the taxpayer can afford as a state health service, particularly for those who can’t.

The English look like they are ready to talk about this. From former Prime Minister Tony Blair, to former Health Secretary Sajid Javid to Health Secretary-in-waiting Wes Streeting, they are opening up to the population and presenting them with home truths.

Here, in Scotland, not so much. It’s time now, though. Otherwise, all that lies ahead of us are broken wallets, broken bodies and broken hearts.

Andy Maciver is Founding Director of Message Matters and Zero Matters