Britain Refuses to Admit Health Service’s Failure

Britain’s National Health Service is failing by any measure but no one is willing to acknowledge as much.

A hospital in London, England, February 21, 2010
A hospital in London, England, February 21, 2010 (Lars Plougmann)

There is no denying Britain’s National Health Service (NHS) is in trouble. Fifty years ago, it consumed only 3 percent of economic output. Now it consumes 8 percent and is on track toward claiming almost a fifth of gross domestic product by 2060 if current spending levels are sustained. By then, the NHS would account for half of public spending, crowding out defense, education and welfare.

The current government has done little to reverse this trend. It shielded the NHS from spending reductions while most other departments were forced to make deep cuts. Indeed, health spending is up 3.6 percent since the Conservatives and Liberal Democrats came to power in 2010. The NHS budget is £114 billion this year.

Even so, care is lacking and the money remains tight. Three million patients are waiting to be treated. The health service itself expects to post a £30 billion shortfall by the end of the next parliament.

Yet the ruling parties are backing away from their own reforms which were meant to rein in costs. The coalition gave health officials more autonomy and handed control of purchasing care to local doctors. This modicum of competition and decentralization was slammed by the opposition Labour Party as tantamount to undermining the whole system where it actually built on cautious liberalizations brought in under the previous Labour government.

If the Conservatives are now shrinking from the problem, Labour simply denies there is one. It rules out privatization and charging users for some health services. Instead, it wants to roll back reforms made under both the last Labour government and by the coalition and merge social care, which is run by local authorities, with the National Health Service. Yet the party has no plan for how to pay for this all — unless one counts its vague pledges to raise taxes on the rich.

Short of partial privatization — which should start with the introduction of subsidized private health insurance, such as in the Netherlands, or compulsory saving accounts, such as in Singapore — there are changes that could be made to improve the British system.

According to the Academy of Medical Royal Colleges, the NHS wastes more than £2 billion each year on unnecessary treatments and overprescribed drugs. The introduction of a small fee for treatments and medicine could reduce demand for unneeded care and make patients more aware of the costs.

Smaller hospitals should team up to share administrative costs. Local doctors, dentists and nurses should be allowed to carry out relatively simple procedures that don’t require a hospital visit. And the NHS should be allowed to continue issuing contracts to private health-care providers — something the Labour Party wants to cancel.

This is not a matter of “people versus profits,” as the left insists. Rather, it’s a question of how to control costs and improve quality at the same time.

The NHS doesn’t do bad in international rankings but that is in part because it has no barriers to access. Looking at quality alone, other European countries do better — and they’re often cheaper at it. It’s no coincidence that those countries that have introduced market reforms in their health-care systems are pulling ahead of the United Kingdom.

It’s also no coincidence that quality is lacking in Britain’s collectivized system. This was established by the National Health Service’s own ombudsman who stumbled on a disconcerting “attitude” in the institution in 2011, one that “fails to recognize the humanity and individuality of the people concerned and to respond to them with sensitivity, compassion and professionalism.” He said at the time the NHS was “failing to meet even the most basic standards of care.”

Throwing more money at the NHS won’t do when it is falling short because of what it is: a political sacred cow that is unaccountable to its patients.

As long as the British refuse to recognize that the NHS isn’t perfect and prefer to believe it cannot possibly be improved, don’t expect their politicians to tell them any different.