Both Left- and Right-Wing Critics of the NHS Have a Point

The system could use more money, but in the long term British health care needs liberalization.

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

Crises in Britain’s National Health Service (NHS) always provoke the same ideological debate: the right blames “socialized medicine”, the left calls for more money.

Neither side is completely wrong.

The Financial Times argues there are too many administrators and not enough frontline medical staff in English hospitals.

Repeated government reforms have spurred fragmentation and only added more layers of bureaucracy.

But “cuts” (really: restraint in the growth of health spending) haven’t helped, especially when the population is aging and requiring more services.

The result:

  • Tens of thousands of patients have seen their surgery postponed this winter.
  • Targets for waiting lists and times have been dropped.
  • Accident and emergency centers are close to breakdown.
  • Patients are lined up on trolleys in the absence of hospital beds.

It’s not just money

Throwing more money at the NHS won’t solve Britain’s problems in the long term.

Britain’s doesn’t compare unfavorably to the health systems of other rich nations, but that is in part because it scores so well on access. All Britons have access to health care, free of charge.

In terms of quality, Britain’s neighbors across the North Sea do better.

Part of the problem, as the NHS’s own ombudsman reported several years ago, is a bureaucratic mindset that saps initiative and fails to treat people with “sensitivity, compassion and professionalism.”

Another is opposition, both from inside the system and the Labour opposition, to decentralization.

The last Conservative government gave health officials more autonomy and handed control of purchasing care to local doctors. Labour slammed this as a step toward “privatization”, discouraging further reform.

Things Britain could do

Privatization along Dutch lines, with private health insurance, publicly-owned hospitals and subsidies for low incomes, wouldn’t be such a bad idea. The Netherlands has ranked number one in the Euro Health Consumer Index (PDF) for the last three years. Britain places fifteen out of 35 countries.

But such an overhaul is unlikely so long as the British continue to disregard the evidence and believe their health system is already superior. (A problem that will sound familiar to Americans.)

There are changes that could be made within the current system to save money and improve outcomes:

  • The NHS wastes an estimated £2 billion each year on unnecessary treatments and overprescribed drugs. Introducing a small fee for treatments and medication could reduce demand for unneeded care and make patients more aware of the costs.
  • Small hospitals could team up to share administrative costs.
  • Lawmakers could allow local doctors, dentists and nurses to carry out simple medical procedures that don’t require a hospital visit.
  • The NHS could issue more, not fewer, contracts to private health providers.