Whatever the outcome of Brexit, we cannot continue to pretend that Europe has nothing to teach us about healthcare financing and delivery. By Peter West
I have recently been reading On the Psychology of Military Incompetence by Norman Dixon. I have not finished it so please, do not send me any spoilers.
But its catalogue of military disasters, combined with a TV discussion on the NHS, led me to look up two dates. The first is the invention of the machine gun – 1884 if we credit Maxim with the invention of a really efficient machine gun that was effectively the model used for much of the following century – and the end of the military use of cavalry by the British Army – which I understand took place in the 1920s.
Whatever your view on the bravery and bravado of the British cavalry regiments, there is no denying that horses make a pretty big target for a machine gun, compared to a man lying prone on the mud. It took 40 years and the massacres of World War I to convince the army that horses had had their day.
I was put in mind of this while watching Kate Andrews of the Institute of Economic Affairs, a pro-market think tank with a long pedigree, debating on This Week with Alan Johnson and Anna Soubry, about the state of the NHS. Ms Andrews is an American but with no love of US healthcare.
She bombarded the two politicians with statistics about the better performance of European health systems and rejected all suggestions that, in some way, the NHS was fairer than care in much of western Europe that enshrines access for all.
It felt like déjà vu. I knew I had heard the politicians’ arguments recently. And then I realised, I had only just read them in Nixon’s book. How could we expect an army with many regiments, reared on and with their horses, to accept that the machine gun had finished the cavalry and that the tank was probably the only way forward?
Hardly a good deal
In the same way, how can we expect politicians who have known nothing but the NHS, as their care provider but also their political comforter, to even think for a moment that the NHS is not the best in the world.
At a time when the NHS has cancelled elective care for a month to get through winter – rather like solving the road congestion problem by banning non-work motoring – the prime minister is still prepared to declare that the NHS is the best healthcare system in the world. It is certainly the one of the fairest health systems in the world but at the moment, today, winter 2018, a key part of that fairest is that almost nobody can get some things for a month or two. A very fair deal but hardly a good deal.
While we are in the process of leaving Europe, I doubt many people will want to think about moving to a European health system. But if not now, when?
European social insurance, heavily supported by government funding but without the iron grip of the Treasury, leaves individual consumers feeling like they have personal insurance and are able simply to go out and buy their healthcare, with their insurer picking up almost all the bill.
They are not subject to global cash limits or commissioning restrictions but simply go and get what they need from providers who get paid to deliver it. Of course, it may cost more but there is probably a majority of people in the UK prepared to pay more for the NHS so a lower cost is not the best defence of the NHS.
And consider the principle of the NHS applied to other areas of loss and insurance. Suppose that car insurance was nationalised so that instead of getting your car fixed after an accident, you had to join a queue at a government garage which would fix your car according to waiting list criteria and their assessment of urgency.
How does that feel? You cannot drive to work or take the kids to school but nor can you influence when your car will be fixed. I do not find the prospect appealing. Now think about home insurance on the same basis. Just join the waiting list to be rehoused after a flood, when the system gets round to you. In neither of these markets is private insurance perfect but I doubt many would prefer to rely on an NHS style bureaucracy to help them instead.
Then again, consider how you would feel if every child minder and nursery in your neighbourhood and beyond was taken over by a vast “Community Child Care Provider” of the size and scope of NHS community trusts. Instead of being able to pick and choose your child care, albeit with some money changing hands, you would have to wait for the big bureaucracy to tell you when and where your child would get some tiny number of hours a week of care and support, potentially well below what you and your family could do with right now.
“We will take care of your child between 9.30 and 11.00 every day” is exactly the sort of unhelpful message that many in need of community care get every day.
What to do
So what should we do? The first move must be to throw off the blinkers. It is simply not acceptable to me, and should not be acceptable to you, that the fifth richest country in the world claims to have a plan for winter pressures that involves shutting down a large part of elective care.
Winter comes each year and it not an unforeseen emergency but the planning for it is precisely that, with lower priority activities not sustained but simply shut down. Neither those working in the NHS nor those receiving its services and, incidentally, paying for them, should be willing to accept this state of affairs.
Whatever the outcome of Brexit, we cannot continue to pretend that Europe has nothing to teach us about healthcare financing and delivery. If we do, we will end up like the British Army, clinging to that warm, friendly presence well beyond it had served its most useful purpose. So, if you have the time and the inclination, do have a look at Ms Andrews on This Week.