Finally someone said it, even if it was with caveats. “I’m not going to pretend that the NHS is currently the envy of the world,” said Wes Streeting, shadow health secretary, at an event hosted by Policy Exchange yesterday. He went further, picking his words carefully: “The NHS is in an existential crisis … It is failing patients on a daily basis.” Hear, hear.
We have reached the point in the electoral cycle where senior figures in the Opposition can smell power and are prepared, if not to sacrifice, at least to wave a stick at some of their sacred cows. The Government was wrong to offer more cash to the NHS without insisting on reform, Mr Streeting stated, correctly. He even admitted that in debates about the NHS’s future, it is usually the interests of its staff that come first, while “[the] patient voice is often the quietest voice in the room”. Exhibit A: the nurses’ strike. We are again talking about the interests of producers, not the patients they serve.
The problem with the NHS, however, is not just that its funding demands are outstripping the economy’s ability to supply them. It is systemically flawed. This week, the Institute for Fiscal Studies published analysis showing that the NHS has more staff per patient than ever and yet the number of patients it is treating has actually gone down. It is as if government incompetence, the pandemic and NHS structures have connived to produce the inverse of a magic money tree: a magic disappearing box, where money goes in and vanishes.
What’s odd is that the closer you look at the overall situation in the NHS, the more inexplicable its performance becomes. We are told that there is a widespread staffing shortage and more unfilled vacancies than ever, and it does indeed seem to be the case. Yet the IFS’s data also shows that the NHS has been on a hiring binge that has seen the number of full-time equivalent nurses, junior doctors and consultants all rise by more than 8 per cent in three years. We are told demand is shooting up even faster than supply, yet the cohort of “missing patients”, who simply suffered in silence during the pandemic, has still yet to come back and seek treatment. We are told we have too few hospital beds per patient, yet when the government drastically expanded bed supply by building the Nightingale Hospitals, we were told the limiting factor was not beds but staff.
Most vexingly, we are constantly told that the whole system is chronically underfunded, yet if you compare British state spending on healthcare in 2019 with 18 other advanced economies, as the King’s Fund has done, we are bang-on average at 10.2 per cent of GDP. Excluding the US, which has sky-high spending due to its crazy and inefficient incentive structures, UK spending is slightly higher than average, with Denmark, Australia, Ireland, Italy, Spain and Finland all spending less of their GDP on health. Even per capita, according to OECD data, UK spending is right in the middle of the pack compared to a group that includes the G7, Scandinavia and Western European countries.
Despite this, British mortality rates from avoidable causes are worse than in most of these countries and the pandemic seems to have hit the NHS particularly hard. An EU-OECD report shows that a third of chronically ill British pensioners missed out on care during the pandemic, compared with a fifth in France and a tenth in Germany. UK surgeries for several major types of cancer dropped by double the rates seen in the EU and the number of cataract operations and hip and knee replacements fell through the floor at several times the rate seen in other North and Western European countries.
The NHS, in other words, is delivering less care with more staff – and yet the workforce still isn’t happy. Nurses are on strike and supposedly leaving in droves for easier lives as Amazon workers. Junior doctors, whose numbers have risen 15 per cent since 2019, seem likely to follow suit unless they get a 26 per cent pay rise. All of them are citing stress, high turnover and claims that hospitals are “not safe”. What is going on?
How can it simultaneously be true that we spend as much as any advanced country on health care, yet at the same time our hospitals are massively under-equipped and our staff so underpaid they keep migrating to Australia? Where is the money going? Are there choke points messing up the whole system, like falling GP numbers or our terrible scarcity of capital equipment (MRI machines, mammograms and so on)? If there are, why can’t these be urgently identified and addressed? Like a fascinating but terminal patient, the NHS has consultants, wonks and politicians crawling all over it, but none of them seem able to tell us why it has gone wrong.
Here is one thing we do know. The NHS model isn’t working. It is never able to plan ahead. It doesn’t invest. It cannot retain staff. There is no point bunging more and more money into this system without first understanding how to put it to good use. If rising health-care costs are simply a corollary of our ageing, sickening population, then efficiency improvements and innovation are indispensable. The system we have does not incentivise these improvements.
And here is where we hit the limitations of Mr Streeting and Labour’s appetite for reform. A system ideologically wedded to one size for all, in which contributory payments and gradations of care are forbidden, is one where patients will always be supplicants. Some dedicated staff might go the extra mile to serve these ailing supplicants out of the goodness of their hearts. There might even be wards or clinics where this is the prevailing culture. But the system as a whole will never reinvent itself or take risks in order to increase capacity and serve patients better because such improvements are not rewarded. It is set up to treat patients like fungible tokens that can be slotted in and out at will, rather than to find increasingly convenient, personalised and effective ways of treating them.
The result is not “equality”, as Labour imagines, but a brittle institution that operates by rationing and luck of the draw. Its most senior planners are immune to feedback and have little reason to forestall problems, because when the next crisis arrives it inevitably generates another big cheque from the government.
Mr Streeting ludicrously claims that the NHS is “Britain’s greatest achievement”. This, like all the other similar statements issued by politicians, is a neurosis that has nothing to do with reality or effective reform. Patients don’t care if the NHS a is source of national pride or a slick logo for a T-shirt or a weird centrepiece for an Olympic ceremony. They just want it to provide medical treatment quickly and effectively. As to why it doesn’t, we are still awaiting a convincing diagnosis.
Because it’s been deliberately underfunded in order to make this exact argument.
Oh shove it telegraph, your as outdated as your name sake and it shows
Because we don’t need a new model, we need a new, competent government which is committed to the public realm.
Its deliberately underfunded so that they can introduce an american style model where we need to pay ridiculous prices just for a paracetamol. Look at american pricing models and you will see that the NHS is a godsend. Americans pay 100’s of dollars just to hold their babies after birth. It’s a scam and one that american big pharma are trying to use here.
It’s not failing ,it has been failed by deliberate disinvestment by the UK govt. We need a new model of democracy , there is no mandate to sell off the NHS.
The Torygraph spinning their Master’s agenda again.
It’s failing because the Tories have underfunded it in favour of their pal’s private business models.
This cancer of a Government need to fucking die in a hole, alone.
[deleted]
Failing and being made to fail are two different things.
Don’t understand here why people will accept the demographic make up of the country is changing / ageing, accept that theres not enough staff and yet be entirely opposed to any change in how things are organised.
What’s so terrible about doing things like Germany.
You have to wonder what Simon Stevens is doing sitting in the house of lords.
Its also mostly been ignored That the new CEO of NHS England Amanda Pritchard issued statement earlier this year that NHSEngland will be down sized by at least 30% and upto 40% by end 223/24.
big numbers with massive margin of error. Make one thing clear. The is only one intent and that is to pull the carpet on english health care.
Because any alternative model will either kill people by charging them or take so long to implement that no government wants the hassle.
There is no need for a “new model”. Just fund the one you’ve got!
Or was the red bus a lie? Oh right… It was a lie.
Everyone that says, “We wouldn’t have to be like America! We could use a different model!”, sounds a lot like the Brexiters that were claiming we could use the Swiss/Norwegian/anyfuckingthingelse post-exit.
We could. We won’t.
The model.works ok if properly funded.
The detractors say it is too big….yet if you look at the companies that do best it is the Amazons and the like that are bigger not smaller. The NHS has great imfluce on drug pricing and other contacts and the corporate classes hate that, so they defund it. When better funded a decade ago.it was one of the most effective and value for money systems
Wes Streeting is happy to help the right wing dismantle the NHS.
We know it needs a new model (better direct access, less red tape, less delays, better care, less waste), we just disagree that that is insurance and private sector. If you don’t fix the other end of the system too it doesn’t fix the service… it just makes it for profit AND broken.
Also having worked as a temp in the past in the system its not the staffs fault often for most of this.
The Tory party wants the NHS to fail so that everybody will be forced to private medical practices. Who owns them? Tories.
Didnt they already pretty much sell it off to some Merican company?
19 comments
[Archive link](https://archive.vn/FaK60). Article text follows.
—
Credit: Juliet Samuel
Finally someone said it, even if it was with caveats. “I’m not going to pretend that the NHS is currently the envy of the world,” said Wes Streeting, shadow health secretary, at an event hosted by Policy Exchange yesterday. He went further, picking his words carefully: “The NHS is in an existential crisis … It is failing patients on a daily basis.” Hear, hear.
We have reached the point in the electoral cycle where senior figures in the Opposition can smell power and are prepared, if not to sacrifice, at least to wave a stick at some of their sacred cows. The Government was wrong to offer more cash to the NHS without insisting on reform, Mr Streeting stated, correctly. He even admitted that in debates about the NHS’s future, it is usually the interests of its staff that come first, while “[the] patient voice is often the quietest voice in the room”. Exhibit A: the nurses’ strike. We are again talking about the interests of producers, not the patients they serve.
The problem with the NHS, however, is not just that its funding demands are outstripping the economy’s ability to supply them. It is systemically flawed. This week, the Institute for Fiscal Studies published analysis showing that the NHS has more staff per patient than ever and yet the number of patients it is treating has actually gone down. It is as if government incompetence, the pandemic and NHS structures have connived to produce the inverse of a magic money tree: a magic disappearing box, where money goes in and vanishes.
What’s odd is that the closer you look at the overall situation in the NHS, the more inexplicable its performance becomes. We are told that there is a widespread staffing shortage and more unfilled vacancies than ever, and it does indeed seem to be the case. Yet the IFS’s data also shows that the NHS has been on a hiring binge that has seen the number of full-time equivalent nurses, junior doctors and consultants all rise by more than 8 per cent in three years. We are told demand is shooting up even faster than supply, yet the cohort of “missing patients”, who simply suffered in silence during the pandemic, has still yet to come back and seek treatment. We are told we have too few hospital beds per patient, yet when the government drastically expanded bed supply by building the Nightingale Hospitals, we were told the limiting factor was not beds but staff.
Most vexingly, we are constantly told that the whole system is chronically underfunded, yet if you compare British state spending on healthcare in 2019 with 18 other advanced economies, as the King’s Fund has done, we are bang-on average at 10.2 per cent of GDP. Excluding the US, which has sky-high spending due to its crazy and inefficient incentive structures, UK spending is slightly higher than average, with Denmark, Australia, Ireland, Italy, Spain and Finland all spending less of their GDP on health. Even per capita, according to OECD data, UK spending is right in the middle of the pack compared to a group that includes the G7, Scandinavia and Western European countries.
Despite this, British mortality rates from avoidable causes are worse than in most of these countries and the pandemic seems to have hit the NHS particularly hard. An EU-OECD report shows that a third of chronically ill British pensioners missed out on care during the pandemic, compared with a fifth in France and a tenth in Germany. UK surgeries for several major types of cancer dropped by double the rates seen in the EU and the number of cataract operations and hip and knee replacements fell through the floor at several times the rate seen in other North and Western European countries.
The NHS, in other words, is delivering less care with more staff – and yet the workforce still isn’t happy. Nurses are on strike and supposedly leaving in droves for easier lives as Amazon workers. Junior doctors, whose numbers have risen 15 per cent since 2019, seem likely to follow suit unless they get a 26 per cent pay rise. All of them are citing stress, high turnover and claims that hospitals are “not safe”. What is going on?
How can it simultaneously be true that we spend as much as any advanced country on health care, yet at the same time our hospitals are massively under-equipped and our staff so underpaid they keep migrating to Australia? Where is the money going? Are there choke points messing up the whole system, like falling GP numbers or our terrible scarcity of capital equipment (MRI machines, mammograms and so on)? If there are, why can’t these be urgently identified and addressed? Like a fascinating but terminal patient, the NHS has consultants, wonks and politicians crawling all over it, but none of them seem able to tell us why it has gone wrong.
Here is one thing we do know. The NHS model isn’t working. It is never able to plan ahead. It doesn’t invest. It cannot retain staff. There is no point bunging more and more money into this system without first understanding how to put it to good use. If rising health-care costs are simply a corollary of our ageing, sickening population, then efficiency improvements and innovation are indispensable. The system we have does not incentivise these improvements.
And here is where we hit the limitations of Mr Streeting and Labour’s appetite for reform. A system ideologically wedded to one size for all, in which contributory payments and gradations of care are forbidden, is one where patients will always be supplicants. Some dedicated staff might go the extra mile to serve these ailing supplicants out of the goodness of their hearts. There might even be wards or clinics where this is the prevailing culture. But the system as a whole will never reinvent itself or take risks in order to increase capacity and serve patients better because such improvements are not rewarded. It is set up to treat patients like fungible tokens that can be slotted in and out at will, rather than to find increasingly convenient, personalised and effective ways of treating them.
The result is not “equality”, as Labour imagines, but a brittle institution that operates by rationing and luck of the draw. Its most senior planners are immune to feedback and have little reason to forestall problems, because when the next crisis arrives it inevitably generates another big cheque from the government.
Mr Streeting ludicrously claims that the NHS is “Britain’s greatest achievement”. This, like all the other similar statements issued by politicians, is a neurosis that has nothing to do with reality or effective reform. Patients don’t care if the NHS a is source of national pride or a slick logo for a T-shirt or a weird centrepiece for an Olympic ceremony. They just want it to provide medical treatment quickly and effectively. As to why it doesn’t, we are still awaiting a convincing diagnosis.
Because it’s been deliberately underfunded in order to make this exact argument.
Oh shove it telegraph, your as outdated as your name sake and it shows
Because we don’t need a new model, we need a new, competent government which is committed to the public realm.
Its deliberately underfunded so that they can introduce an american style model where we need to pay ridiculous prices just for a paracetamol. Look at american pricing models and you will see that the NHS is a godsend. Americans pay 100’s of dollars just to hold their babies after birth. It’s a scam and one that american big pharma are trying to use here.
It’s not failing ,it has been failed by deliberate disinvestment by the UK govt. We need a new model of democracy , there is no mandate to sell off the NHS.
The Torygraph spinning their Master’s agenda again.
It’s failing because the Tories have underfunded it in favour of their pal’s private business models.
This cancer of a Government need to fucking die in a hole, alone.
[deleted]
Failing and being made to fail are two different things.
Don’t understand here why people will accept the demographic make up of the country is changing / ageing, accept that theres not enough staff and yet be entirely opposed to any change in how things are organised.
What’s so terrible about doing things like Germany.
You have to wonder what Simon Stevens is doing sitting in the house of lords.
Its also mostly been ignored That the new CEO of NHS England Amanda Pritchard issued statement earlier this year that NHSEngland will be down sized by at least 30% and upto 40% by end 223/24.
big numbers with massive margin of error. Make one thing clear. The is only one intent and that is to pull the carpet on english health care.
Because any alternative model will either kill people by charging them or take so long to implement that no government wants the hassle.
There is no need for a “new model”. Just fund the one you’ve got!
Or was the red bus a lie? Oh right… It was a lie.
Everyone that says, “We wouldn’t have to be like America! We could use a different model!”, sounds a lot like the Brexiters that were claiming we could use the Swiss/Norwegian/anyfuckingthingelse post-exit.
We could. We won’t.
The model.works ok if properly funded.
The detractors say it is too big….yet if you look at the companies that do best it is the Amazons and the like that are bigger not smaller. The NHS has great imfluce on drug pricing and other contacts and the corporate classes hate that, so they defund it. When better funded a decade ago.it was one of the most effective and value for money systems
Wes Streeting is happy to help the right wing dismantle the NHS.
We know it needs a new model (better direct access, less red tape, less delays, better care, less waste), we just disagree that that is insurance and private sector. If you don’t fix the other end of the system too it doesn’t fix the service… it just makes it for profit AND broken.
Also having worked as a temp in the past in the system its not the staffs fault often for most of this.
The Tory party wants the NHS to fail so that everybody will be forced to private medical practices. Who owns them? Tories.
Didnt they already pretty much sell it off to some Merican company?