The NHS is 60 years old.
Any criticism of this national institution is usually spun as criticism of the sainted nurses and doctors who work therein. Let's get this straight. It isn't. It's bureaucrats I hate, not the medical profession. It's socialism, the root cause of Bureaucrats I blame for rubbish hospitals, not the poor bloody infantry dealing with the skewed incentives built into the system of healthcare delivery that a vindictive, spiteful and short-sighted government put in place after the second world war.
Now, the NHS enjoys the misplaced affection of the people of this country who forget (or have been brainwashed into forgetting) we used to have a world class health service before it was nationalised, and now we have a distinctly second rate one: on all measures: research, cancer survival, operations, waiting times, cleanliness we perform less well than France, Germany, the Scandinavian countries, Australia, when we had one of the best at year zero. Our Peers have not flattered the NHS by copying it, with good reason.
Now your average lefty will use the word "underinvestment" probably with the words "decades of" beforehand. He will then cite the USA as the counter example. The most intelligent thing to do at this point is punch him in the face. It is not about the money: The UK spends approximately the OECD's average per head on health per capita. What is interesting is that the public spending is more than the rest of Europe, but there is almost no private sector provision in the UK. That is where the difference lies. Nor is the USA's pure insurance with limited state-help the only other option: No other country has an NHS; most have a mixed, decentralised system. No other country's health service is Free to its users.
Health spending in the UK is, and always has been adequate. Despite this we have far fewer doctors per head of population and fewer Nurses than the OECD average. Life expectancy is in the bottom Third, and survival rates for serious conditions are rarely anywhere near average. If you're British, don't get cancer.
The answer is in one of the NHS's founding principles: "free at the point of delivery", and in its name: "National". Because there's no cost to patients, they are more likely to seek unnecessary medical help. This creates costs and removes resources from the deserving. It means an army of bureaucrats is required to direct resources as there is no information on demand coming from a market. Bureaucracy is rarely efficient or responsive and there are inevitable delays in deploying innovative treatments which are made available rapidly to those in insurance-based systems. This explains our poor cancer survival rates. Secondly, if you aren't rationing by price, and no cost is put on time, waiting lists are the inevitable result. They are noticeable for their absence in all other systems. Again delays in seeing specialists are a cause of poor survival rates in the UK for most serious conditions. National means the world's second largest employer has been created. Efficient? Responsive? unlikely!
As a result of this bureaucratic control, politicians see fit to meddle: We're left with ridiculous ideas like Cameron's of fining tax-financed organisations, the PCTs for each hospital acquired infection; or the Prime Minister pontificating on cleaning regimes, as if 1.3 million employees can be micro-managed from the centre. Resources are scarce, and it is important to direct what you have most efficiently and markets do that most efficiently. It is the "Free at the point of delivery" which ensures that private medicine is a marginal part of total expenditure, and ensures shortages of doctors, equipment and time.
The NHS: the third worst thing to happen to Britain since the war, behind the Welfare state and the European Union. We need to dismantle the NHS, return to local management by doctors who should start charging patients for doctors time. Insurance needs to be built into the system and private cover needs to be tax-deductible.
Unfortunately you need to undo 60 years of Socialist propaganda before the public will accept what needs to be done. Either that or have a Government with balls the size of watermelons, with a mandate to change the system and there's no chance of that happening any time soon.
So Britons will continue to die younger than necessary. Well done NHS.
Wednesday, 2 January 2008
The NHS is 60 years old.