The NHS is not for sale

If you had still had any illusions that our NHS would survive Brexit, these will have been dispelled by the statement of Trump’s ambassador that, “The US will want business access to the NHS in any trade deal”. Indeed, some have speculated that access to the NHS, along with the rest of the economy, is the real reason behind Trump’s visit.

This should come as no surprise, for the “Stronger In” campaign always warned that the country could have Brexit or the NHS, but not both.

The NHS has long been admired by many Americans for its efficiency compared to their own expensive system, at the same time as our own politicians paradoxically sought to emulate the US model by introducing market forces and business practices.

The problem posed by copying Trump’s way of doing things is that we risk losing the close cooperation with Europe that has brought us so much success. A huge threat to both the staffing of the health service and Britain’s leading role in research, is the abolition of free movement. Free movement has been the catalyst for medical advance, enabling the sharing of experience and knowledge as researchers move seamlessly between countries. And on hospital wards all over the country, skilled nurses from many European countries have played a vital role.

Trump is the antithesis of all this, building walls and promoting isolation. The ideology of sheltering behind barriers and looking after one’s own interests first is surely the opposite of what underlies medicine, caring for others less fortunate than ourselves. Nigel Farage, who says he wants an insurance based system, stands beside Trump in one corner, our publicly funded NHS is in the other.

Of course there is much to admire about America, the land of the free, a place from where I have purchased some excellent guitars and many other products, though this is a lot pricier than it used to be due to the weaker pound following the referendum. America minus Trump would be even better, and a good relationship with the country from our position of strength in Europe better still.

But the NHS is a no-go area. We must signal strongly that it is not up for sale.

* John King is a retired doctor and Remain campaigner.

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22 Comments

  • Innocent Bystander 5th Jun '19 - 11:11am

    “The NHS has long been admired by many Americans for its efficiency”
    Eh? Did you make that up? My experience of the NHS is that the people are well meaning but it is the most over managed, bureaucratic organisation imaginable. Only after multiple visits and real pestering by me did my wife get an essential test. Within an hour of the result she was in high dependency with oxygen, drip and canulas.
    Some praise the NHS for the treatment they have had. Lucky them. Lots of us haven’t done so well. There are many other health care models available. Look to Europe for ones that work.

  • According to CBS news the average cost to a patient suffering a severe heart attack in the USA is 760,000 dollars. The medical complaints system is also a major industry. Enough to give one a heart attack in fact.

    Most reassuring to know that the Innocent one seems to imply that he can afford this.

  • Innocent Bystander 5th Jun '19 - 11:40am

    David,
    It is just health care, not a religion. I have no regard for Mr Trump or the bizarre health system they operate. I can only repeat that the NHS is chronically overmanaged and that there are plenty of other countries who manage to provide excellent health care without
    either the UK or US systems.

  • @Innocent Bystander – One of the problems the NHS has, which is common to many large organisations (regardless of ownership style), is inconsistent service delivery levels across their numerous ‘outlets’.

    I’ve seen this first hand where in my area for a specific condition the service has been excellent, however, my relations in another health authority area have, just like you, had to fight to get a hospital admission for the same condition.

    One of the challenges is that training etc. costs money and we can expect the tabloids and others to complain when monies are spent on improving customer service rather than directly on more nurses and doctors…

    Aside: Given how Nigel Farage has been pleading poverty in recent years and (assuming Brexit happens) his imminent lack of income, I’m a little surprised that he is still promoting an insurance-based system.

  • Paul Holmes 5th Jun '19 - 12:28pm

    Of course the better Western European Health systems also spend 30% more per head than the UK does. The NHS is internationally judged to be one of the most efficient Health delivery systems (‘bang for buck’) in the world. Give it 30% more funding and then you can start to make green eyed comparisons with supposedly greener grass elsewhere.

    As for the USA, David Raw makes the point about the crippling cost there of serious illness for the individual. This morning’s news report about the US Drug industry sharpening it’s lobbying knives for Anglo/US Trade negotiations was informative. The USA’s profit driven health care system pays three times more for drugs than the NHS does.

  • John Marriott 5th Jun '19 - 1:51pm

    Yes, bureaucracy is a problem in the NHS. It needs sorting. HOWEVER, I’d rather keep the concept than take a chance with a health insurance scheme, similar to the one which I experienced living in West Germany in the 1970s, which was good but relatively expensive.

    What I would do ASAP is introduce a Health Tax of at least 2p in the pound to go towards health AND social care, with very few exceptions. I would also make sure that we train enough doctors and nurses so that we do not have to poach specialists from elsewhere. We should offer bursaries on the clear condition that all recipients agreed to work for at least four years in the NHS following qualification. Failure to comply should require the repayment of any monies that have been awarded for study.

  • Lorenzo Cherin 5th Jun '19 - 1:51pm

    Such a shame Liberals are so very subjective rather than evidence based, plus look at exactly and precisely what evidence.

    My experience and for my wife , she suffering years in unnecessary discomfort, pain, from a car accident and lack of ongoing treatment, is really quite awful.

    I though, do not deny some get rather good or terrific care.

    The NHS is a very mixed system, various people read into it some all too decisive conclusion.

    John King is mistaken if, other than on equitable access, anybody rates this model, no report does, only on access. This means it is apparently fair because everybody is equal in that long, very , very huge, wait they often have, for care.

    I have seen people left to wither away due to age, literally given delays so they do not get help.

    Because some have a good experience they reckon this is all their is to see or to be said.

    All experiences are valid. They do not refute those that differ.

    The US is a nightmare for some, not all. Medicare helps many, as does medicaid. Most excellent jobs have excellent health insurance. Any of us without either there, suffer.

    To loathe the US model is not, nor should it, be, to love the UK one.

    Most EU countries, get the balance between public and private mix, state and citizen input, more flexible and far better than the US or UK.

    Paul is wrong, it is not just the greater funds, but the better systems.

  • Peter Watson 5th Jun '19 - 1:54pm

    @Paul Holmes “This morning’s news report about the US Drug industry sharpening it’s lobbying knives for Anglo/US Trade negotiations was informative.”
    I’m halfway through Ben Goldacre’s excellent book “Bad Pharma”, and it does indeed demonstrate “how drug companies mislead doctors and harm patients” (though regulators are far from blameless). Unless things have significantly improved since it was published seven years ago, there seems to be plenty there for Lib Dems to promote, with potentially massive cost savings and improved treatment for patients.

  • Oh dear. These discussions of the NHS always descend rapidly into a UK vs USA comparison, along the lines of “the NHS must be brilliant, just look at America”. Well what about France, Australia, Austria and a couple of score other nations who have a blend of insurance and tax funding and who seem to be getting better outcomes than us ?
    We are (probably) all agreed that health care must remain free at the point of delivery and administered on the basis of need rather than ability to pay, but if those two tests are met, surely we can think outside the box a little ?

  • Martin Land 5th Jun '19 - 2:21pm

    It would be easy to make the NHS more cost effective. The bureaucracy is frightening and simply failing to properly support medical staff and patients. I would also say that some of the NHS unions seem to be nothing more than self-serving lackeys to the government and the NHS management. The RCN seems particularly bad. I think healthcare needs a considerable boost in expenditure but I would be reluctant to put it into this bottomless pit.

  • Peter Martin 5th Jun '19 - 2:29pm

    “Yes, bureaucracy is a problem in the NHS. It needs sorting”

    We’ve heard this kind of comment countless times. All large organisations need managing or organising. The armed forces, local councils, central government, the EU, British Airways, etc. It’s very easy for politicians to say that they’ll cut the bureaucracy and services will remain uncut. What happens? Services are cut.

    I’m not saying the NHS is ideal but is it any worse than we might expect? Where’s the evidence?

    https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita

  • Paul Holmes 5th Jun '19 - 2:34pm

    @Chris Cory. In my comment I specifically addressed BOTH the USA and equivalent Western European systems.

    We are told a lot (by some) about the better systems in say Germany or France or Sweden. We are told that some are better because they have Health Insurance (that was in the controversial David Laws chapter in the Orange Book -which he didn’t let other contributors see before publication, contrary to the agreed procedure the others followed). But what is not emphasised is that they spend up to 30% more per head of population. So is it the extra 30% spend or the personal Health Insurance that makes the difference?

    Not that money alone is the only factor of course. Back in the wonderful USA they spend (overall) more per head of population than anyone else in the world. However those on lower incomes have some of the worst health outcomes -and that is not ‘just’ the ones who cannot afford any Health Insurance at all.

  • @Paul Holmes. Fair enough. My comments were aimed more at other posters than your good self.
    I take your point about many Western European countries spending more per head on health care, although I believe the extra spend you mention is arrived at by adding government expenditure and private insurance together. But I agree we need to get more money into the system.
    A hypothecated tax, eg an extra 1% ring fenced for the NHS, sounds like an answer but might not be as popular in practice as it appears in theory.
    No one is suggesting (well I’m not) a system where if you don’t have insurance you don’t get treated, but we could look at a levy on the better off who don’t have private health insurance, similar to the Australian system.
    And as you note, higher per capita spend in the USA has not done much for the health outcomes of low income groups. Be that as it may, it must be worth looking at the way many of our continental neighbours achieve superior results in the treatment of cancer. Is that just down to money, or are they doing things differently ?

  • Innocent Bystander 5th Jun '19 - 3:44pm

    What does “up to” mean in the 30% claim?
    Looking at the actual numbers we are right in our peer group and only seriously behind Norway and Switzerland and a few percent behind others (and ahead of most).

  • chris moore 5th Jun '19 - 6:59pm

    Simon McGrath 5th Jun ’19 – 6:10pm You could have a slightly higher % provided by private firms – why would that be a bad thing?

    I live and work in the Spanish Basque country and use the regional Basque health system. Per capita overall spending – public plus private – is less than the UK average.

    However, overall, outcomes are superior, particularly for common, but serious diseases like cancer and heart conditions. The same can be said of routine operations – hip replacements, hernias etc etc

    Why?

    1. There is more flexibility in the system. There is no hesitation to farm out operations to private providers, when public waiting lists are too long. I myself have had an operation in this way at a private Catholic hospital.

    2. The culture of Osakidetza is less defensive than the NHS. They are ore open to crticism – indeed, it’s mandatory to draw patients’ attention to complaint forms. No self-deluded nonsense about being the best health service in the world.

    3. Doctors are paid less and nurses. (Just saying! Don’t shoot the messenger!) Hence more resources available for treatment.

    4. Better organised. Well run public health campaigns checking a variety of conditions. I believe they take prevention more seriously.

    Basque life expectancy is one of the highest inthe world. Osakidetza is part of that.

    And I’m sure there are many other reasons.

    I don’t want to give a utopian impression of Osakidetza. There are many problems and, as ever, with public systems, a lack of resources.

    (One área where the NHS is better is end-of-life care.)

  • Beware of reactionists and tagalongs. They start of with trashing the existing position, claim their change will come without cost and then when they get their way present you with a nightmare. Not so innocent is a Reactionary Brexiteer, he won’t be happy until we are back to an age where the poor suffer (for their own good of cause) and he and his ilk can feel good handing out crumbs. Their philosophy is not one for the common good, it is ment to make him feel superior. A nasty self defeating philosophy, but an insidious one and one that should be stamped into the ground.

  • The NHS has been judged the best, safest and most affordable healthcare system out of 11 countries analysed and ranked by experts from the influential Commonwealth Fund health thinktank.

    It is the second time in a row that the study, which is undertaken every three years, has found the UK to have the highest-rated health system.

    https://www.theguardian.com/society/2017/jul/14/nhs-holds-on-to-top-spot-in-healthcare-survey

    So for those pushing their own agendas, crying it could be better. Well yes it could but only if you put your hand in your pocket, if you don’t marvel how much you get for so little. Beware the siren voices, promising the world for nowt, they did that with Brexit, at best they are useful idiots at worse they are attempting to obtain wealth and power at mine and your expense.

    By the way Peter everything you say is correct, but why then did you vote to empower the people who will destroy the NHS, trulely that idiot in the mirror isn’t going away. You have been played my dear delusional Lexiteer, they must be very amused.

  • https://www.theguardian.com/society/2017/jul/14/nhs-holds-on-to-top-spot-in-healthcare-survey

    If you want a better health service pay for it, if you believe you don’t have too, don’t be surprised as the burden of an aging population wash over the NHS it buckles. Of cause some of you may be rich, but you’ll need to be very rich to obtain decent health care as you age. You don’t get nowt for nowt and if you think you do more fool you.

  • Thanks for these comments.

    My impression is that the early NHS of Bevan was the most efficient, but that when Thatcher got hold of it and we had the internal market and the purchaser-provider split, rafts of managers came in to implement those changes.

    The old Dr. Finlay style of working when you could get hold of your GP round the clock has largely gone of course but it did exist, as did an impressive NHS estate. The lovely NHS buildings in London where I once worked are now blocks of flats for the rich. The family jewels have been sold off to pay the gas bill, as it were.

    Chronic underfunding has brought this about, but the spirit of public service still survives and can best be preserved and built upon if we are able to remain in the EU.

  • Peter Martin 5th Jun '19 - 9:47pm

    @ frankie,

    I didn’t vote for anyone in the EU elections.

    @ John King,

    The EU aren’t protectors of the NHS. I’m not sure why anyone thinks they are? They aren’t keen, to say the least, on the idea of a Nation State nationalising anything. Which is essentially what the NHS originally was. Totally nationalised healthcare. That’s been chipped away at over the years. It’s all, as you say, about internal markets now. And it’s all happened while we’ve been in the EU or its predecessor organisations.

    Naturally the Lib Dems want to make the case that we have to stay in the EU “to be able to afford” the NHS and somehow the EU will keep those nasty Americans away from it. It’s a mixture of political propaganda and wishful thinking. There’s an old saying that if you want something doing properly do it yourself. Don’t rely on anyone else.

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