There are alternatives to the NHS but we must face up to its failure

 
James Bartholomew
THERE is a scene near the beginning of the film Casablanca when a crime takes place. In response, the chief of police commands, “Round up the usual suspects!” He knows this will not reveal the culprit. Doubtless, his staff know too. Everybody knows. But at least he can say he is taking action.

The response to the horrific events at Stafford Hospital is not wholly different. David Cameron has announced that a chief inspector of hospitals is going to be appointed. Robert Francis QC, the author of the report into the scandals at Stafford, made no fewer than 290 recommendations. All this might be convincing if we had not been here many times before. Ever since the NHS was created – by the most left-wing minister in the post-war Labour government – there have been serious problems, followed by reforms that were meant to solve everything.

In the 1970s, one government thought that re-organisation recommendations by the management consultancy McKinsey would make things better. More recently, the introduction of “professional management” was going to improve it. Then targets were the answer. In fact, targets were part of the reason why Stafford treated its patients so badly. I remember speaking to a surgeon who was incandescent after a weekend in which he had been instructed to operate on people with minor problems. Others who had just broken their hips lay in great misery and discomfort and had to wait until Monday. Why? To meet targets.

Over the past year and a half, I have visited 11 countries, looking at their welfare states. I was trying to discover the best possible healthcare system. I would not claim to have found the perfect answer, but one thing is clear: the NHS is not it. In fact, the NHS has claims to being the worst healthcare system in the advanced world.

If you look at most measures, the UK comes out badly. Breast cancer survival rates? One of the worst. Colorectal cancer survival rates? One of the worst again. Number of MRI scanners per capita? One of the lowest. Number of CT scanners? Same again. The OECD did a study to work out which of its member countries got the best healthcare in relation to the amount of money spent. The British NHS was one of the worst. It is not even good value.

There is no need to reform the NHS. It needs to be abolished. I mean no disrespect to the doctors, nurses and others in the NHS, who work in extremely difficult conditions. Their efforts are all the more admirable given that they persist in discouraging circumstances. I also don’t mean that nothing should replace the NHS. International evidence shows that there is an array of alternatives we could use instead. Britain could have a social insurance system – like most of western Europe – or a health savings system, or a combination of the two. In any case, there should be an element of competition.

The essential flaw is the fact that the NHS is a monopoly. When providers know you might take your custom elsewhere, they shape up. That is what is lacking. Choice and competition exist in practically every other system in the advanced world. In the Netherlands and Switzerland you can choose your insurer. In France, you can choose your doctor and can go straight to a consultant without visiting a GP. In Singapore, everybody has a health savings account and can use the money in it to pay for their healthcare.

People will say that the British love the NHS. It even featured in the Olympics opening ceremony. In reality, this love is skin-deep. I once took part in a BBC Radio 4 programme in which I advocated the abolition of the NHS. When I told others I was doing this, they were surprised and some were shocked at first. But then they would pause and say something like, “Actually I remember when my father was in hospital. He was left alone for hours, disoriented and ignored.”

During the programme itself, I was challenged by experts in the studio and members of the public phoning in. Afterwards, the producer looked astonished as he told me that the calls and texts had broken clearly in favour of people agreeing with me.

The deaths at Stafford were not an aberration. They were the tip of an iceberg. Most NHS deaths, such as cancer treated too late or with out-of-date drugs or not at all, go unrecorded. How many people have to die unnecessarily before we accept that the NHS – a state monopoly – is inherently a bad system? For the sake of those we love and for ourselves, it must go.

James Bartholomew is author of The Welfare State We’re In, which is to be republished later this year.