Wednesday, 8 June 2011

Let’s all stop being so sickeningly sentimental about the NHS

I wouldn’t be here if it wasn’t for the NHS. My mother might not have enjoyed a further twenty healthy years were it not for the treatment she received after suffering a heart attack in her late 50s. We all have stories like this to tell. I’d be surprised if the NHS hadn’t played a crucial role in all our lives. So bloody what! 

The NHS has, apparently, become a symbol of Britain’s organisational excellence and of our deep compassion: in fact, for many, it has become the defining symbol of Britain itself. The organisation must never be changed in any way whatsoever, except that it must, of course, be allowed to expand and become more bureaucratic and cost us all a lot more. Any attempt to reform it is effectively an act of sacrilege. Money is no object: if it takes the whole of our Gross National Income to keep it going, so be it – it would be a price worth paying. It is “safe” in every government’s hands, because no politician dares criticise it, or seek to change it in any way, and expect to survive.  

Of all the many signs of our seemingly inevitable slide into wholesale irrationality, the NHS is the most baffling.

We’re talking about a system for delivering health care -  nothing more, nothing less. This system seems to work okay, on the whole, but it’s enormously costly and bureaucratically top-heavy and standards of care in some hospitals are evidently appalling. 

The Health Service is morally neutral. It can’t be “good” in the way that an individual human being can be good. It can only be judged in terms of effectiveness and value for money. When the NHS saves people’s lives or makes them better, it isn’t a question of saint-like self-sacrifice on the part of its employees. They are trained professionals paid a salary to do these things. It’s a health service – it’s supposed to save lives and make us better. Those noble, self-sacrificing souls who pay tax and National Insurance expect the NHS to be there to help them when things go wrong:why should we be surprised when they do what we pay them to do? As for gratitude, I’m as grateful to the NHS as I am to, say BT – the levels of competence are about the same. (If the NHS performed as well as Sky or Apple, mind you, I’d be really grateful.)

We on the Right tend to revere ancient institutions and worry about attempts to interfere with them in case the very fabric of society unravels (and because we like old stuff, especially if doesn’t have a very obvious point). But the NHS is only 63 years old. In that time, the general belief in its innate virtue has taken on religious overtones: the left are fundamentalists, centrists are the liberal wing of the religion, and right-wingers are heretics. (Certainly, there are religions younger than the NHS, but they’re all crap.)

When considering the future of the NHS, it’s natural to start by looking at who controls the budget - after all, it costs us an absolute bloody fortune. But there are hundreds of other questions that need answering, all of which have cost implications. For instance,  what level of respect do we expect it to accord patients (no mixed-sex wards, referring  to adults as Mr and Mrs, making sure that old people aren’t left to die of malnutrition and dehydration, and emptying the occasional bed-pan would be a nice start)? Should it go on providing pointless, costly treatments such as liver transplants for degenerate alcoholics and drug addicts?  Are there anycircumstances in which the NHS should fund IVF treatment? Does the battle to prolong the lives of many old people constitute cruelty? Should the NHS treat people who are abusive, violent and disruptive through drink or drugs?  At what stage should the NHS stop treating lard mountains on the grounds of futility? Should it hire doctors and nursing staff from abroad when many young British doctors can’t find work? Should it hire doctors and nurses who are incomprehensible to native-born English speakers? When does it start firing and possibly prosecuting cleaners, nurses and administrators for tolerating levels of filth that encourage superbugs to proliferate (fining the hospital strikes me as an hilariously unproductive course of action designed to harm patients)? Could it refuse to treat recent immigrants for treatment during, say, their first two or three years in the country, and for any conditions which had already been diagnosed when they entered Britain? Could it refuse treatment to certain types of criminal?

Life is all about trade-offs. But the NHS, being, like God, ubiquitous, universal and all-loving,  is expected to treat everybody for everything, and that’s why most of my questions won’t even be discussed. To do so would be sacrilegious. So, instead, we just keep trying to shuffle budgetary responsibility from one set of people who have no financial training and no  incentive to spend less to another set of people with similar attributes. And so awed are we by the moral glory of this institution - we’re not even allowed to do that!

While we go on pretending the NHS is different from any other nationalised industry – with some of the benefits and all of the faults that implies – the bloody thing will never improve: it needs major surgery, not a couple of aspirin.


  1. In 1985 the military historian, Correlli Barnet, published a book called "The Audit of War". Here are a few quotes :
    "While in 1940-1 Winston Churchill and the nation at large were fighting for sheer survival...members of the British cultutal elite had begun to busy themselves with design studies for a "New Jerusalem" to be built in Britain after the war was won...Universal free health care in elegant, modern hospitals and in health centres on the Swedish model would replace grim and run-down Victorian infirmaries and the ragged safety netting of existing free medical services."

    "Ironically the vision emanated from the same kind of people, indeed in some cases the very same people, whose earlier Utopian vision of a world saved from conflict through disarmement and the League of Nations had done so much to bring about Britain's desperate plight in 1940-1, by persuading British governments in the 1920s unilaterally to disarm, so rendering Britain helpless in the face of aggression in the 1930s.....for New Jerusalemers and pre-war moralising internationalists alike were drawn from the Labour and Liberal parties....what may be collectivelly termed the "enlightened" Establishment."

    In March 1941 Britain basically ran out of money. Financial reserves were at an end payments currently due to America for war supplies were met through a loan of gold supplied by the Belgian government in exile. Effectivelly, the country was bankrupt. On 11th March the Lend-Lease Act kicked in and Britain was transformed from a bankrupt into an American pensioner. By 1945 $27b in terms of food and raw materials, American industrial and military equipment had flowed into the country. Because Britain was then not therefore required to earn her own living nor wage war within her own means she was able to turn her economy almost entirely over to waging war. Sir William Beveridge [and the country as a whole] misinterpreted this.

    Lend-Lease ceased abruptly in August 1945. The National Health Service [and the various other parts of Labour's Welfare State] kicked off in 1948 off the back of a further loan of $3.7b from the Americans negotiated by Keynes. The original cost of the NH was put at £53m - it doubled between 1949-50 and 1951-2. In spite of their great wealth the Americans decided they could not afford to provide a free health service for their own country - and still don't in spite of the efforts of various Democratic Presidents. Britain certainly could not afford it in 1948 and frankly it still can't. Tout Court.

    Final quote and final paragraph from the "Audit of War" - "By the time they took the bunting down from the streets after VE-Day and turned from the war to the future, the British in their dreams and illusions and in their flinching from reality had already written the broad scenario for Britain's postwar descent...the dreams and illusions of 1945 would fade one by one - the Imperial and Commonwealth role, the world-power role, British industrial genius, and, at last, New Jerusalem itself, a dream turned to a dank reality of a segregated, subliterate, unskilled, unhealthy and institutionalized proletariat hanging on the nipple of of state maternalism." This was written 26-years ago. Enter Theodore Dalrymple.

    I aplogise for the length of this comment.
    Monday, June 13, 2011 - 11:09 AM

  2. Spectacular quotation, Sir, thank you for typing it all in.
    Monday, June 13, 2011 - 05:52 PM

  3. The last time I was in the Middlesex in Paddington, the overworked young houseman told me that I was the only Brit he'd treated in two days. He was horrified to see my foot wound was in danger of turning gangrenous, and without a hint of irony asked me why I hadn't come sooner.It was then almost 6pm and I'd been queuing in A&E at 10am!
    If the NHS insists on treating half the Third World (almost every patient was dressed in a dishdash), then we all suffer.
    Wednesday, June 22, 2011 - 03:02 PM