I recently asked two wise doctors, senior in their profession, what is wrong with the current NHS. Was it money? Was it recruitment, or pay, or structure? Without consulting each other, they answered in one voice what was wrong: “Us.”
Stories of NHS misery pour in almost daily. Britain is now ranks 30th among the 49 richest OECD countries in terms of infant mortality, with things getting worse, according to the Academy of Medical Sciences. Meanwhile, surgical wait times can increase to five and a half years in Northern Ireland, according to the Royal College of Surgeons. The Times health committee this week the NHS found itself in digital chaos, with “between 40 and 60” types of patient records and 10% of hospitals still entirely paper-based. It wants a nationalized healthcare system, a sugar tax and ‘health passports’.
Those who have been banging their heads against NHS reform will find little new here. Margaret Thatcher and John Major repeatedly tried to turn the NHS upside down, including through decentralization and the ‘marketisation’ of GPs and hospitals. All failed. They simply increased bureaucracy, urged on by management consultants. Costs soared under Tony Blair and Gordon Brown. Nothing seemed to improve. This week, Rishi Sunak admitted he had completely failed to cut waiting lists.
Most prominent public services are facing an efficiency crisis. The hardest hit – medicine, the courts, the universities, the armed forces – are built around deeply conservative professions. But consultants, lawyers, professors and colonels never blame themselves. While British trade unions have seen decades of reform, professional associations have resisted all change. They are adept at avoiding both blame and reform. When two doctors debated the NHS on Monday’s Today programme, they agreed reassuringly that the shortcomings lay elsewhere, in obesity and child poverty.
Of all the industries nationalized by Labor after 1945, the NHS is the most riddled with restrictive practices, guarded by an iron shield of public affection. Last month’s launch of Pharmacy firstIt took 20 years to achieve this, allowing chemists to offer simple drug treatments and save 10 million referrals to GPs per year. The rule that you must be referred by a GP to see a hospital doctor before a cancer scan must surely be the cause of Britain’s poor cancer record.
Medical education is still medieval. The collapse of British dentistry is the result of the profession requiring five years of largely irrelevant study, followed by two years of ‘supervision’. Recent militancy in hospitals has its roots in the long-standing exploitation of “junior” doctors by consultants, and in the subordinate status accorded to senior nurses, largely because most are women.
The Heath government’s centralization of local clinics and health centers in 1974 destroyed the last shred of local government healthcare. It gave general practitioners and emergency physicians absolute control. It meant that for children and the elderly, curing disease – not maintaining wellbeing – became the sole concern of the NHS. Care for the elderly disappeared under the stairs.
Labour’s shadow health minister, Wes Streeting, is likely to take on this burden soon. Like many before him, he breathed the language of reform. He should seek lessons abroad and from Britain’s now booming private sector. But the first question he should ask is: why did all his reformist predecessors fall at the first fence?
The answer is that he must go where no one dares. He must confront and restructure the medical profession. Otherwise nothing will change, nothing at all.