Britain Post Brexit by Peter McGarrick

Author:Peter McGarrick
Language: eng
Format: epub
Publisher: The History Press

Health

Like motherhood and apple pie, the NHS is revered by all. Only an eccentric (and almost certainly unsuccessful) politician would dare to challenge the fundamental benefits of an institution which has, since its formation in the 1940s, dedicated itself to the provision of free healthcare for all.

The NHS is a huge concern. It is one of the world’s largest employers, along with the Chinese Army, Indian railways and Walmart. It has an annual budget in excess of £145 billion, representing nearly 18 per cent of total government expenditure. After welfare, it is the biggest call on the government’s purse.

In recent years, the monolith has been broken up a bit, because the Scottish, Welsh and Northern Ireland health services are controlled by their own assemblies. There is now some divergence in practice between them.

Medical advances reflect the general rapid change in almost all fields of science and technology. Although the proportion of national expenditure devoted to health has consistently gone up, the demand for care, now that more and more is possible, always seems to outpace it. As a result, there are frequent references to the service being in crisis, with overworked, demoralised staff, patients waiting a long time for treatment, a shortage of the latest equipment and medications and overcrowded hospitals.

The news is not all bad. Life expectancy has gone up considerably since the service was founded. Since then, procedures now regarded as routine, such as hip replacement surgery, enable many to live much more active lives than would have been possible before.

There is probably a limitless demand for healthcare, and so some decisions about the allocation of resources are inevitable. Although this is generally recognised, there is a strong sense that this enormous institution could work much better than it does. But, how?

One of the things that all political parties have recognised since the war is the importance of the NHS and the huge benefits it brings to the whole of society. We are committed to the principle on which it was founded, which is that the best healthcare that the country can afford will be delivered free to patients. It is the task of government to make this as efficient as possible. The present system fails in this respect.

Although a great many highly skilled and dedicated people are working very hard within the NHS, they are hampered by an inflexible institutional approach, dogma and an unwillingness to accept changes to working practices. There are stark contrasts between the best-performing units and the worst. The system seems to lack effective mechanisms to alter this position.

Much of this is driven by politics. The NHS is cherished politically, partly because it is, in effect, our largest nationalised industry. Experience shows that nationalised industries very rarely work as well as private ones. The NHS also suffers from the fact that it is, largely, a monopoly.

We should fully embrace the market mechanism in healthcare. Market dynamics improve efficiency wherever they are allowed to operate, and it is perverse to exclude them from so vital a sector.

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