Thursday 5 August 2021

NHS GC knocked off its perch

 It is ironic that our National Health Service, within weeks of being honoured by the award of the George Cross for its sterling work during the pandemic, should be downgraded from 1st to 4th place in the pecking order of developed countries'  health services.

 https://www.theguardian.com/society/2021/aug/04/nhs-drops-from-first-to-fourth-among-rich-countries-healthcare-systems.  

The UK is now in  fourth place, ousted from the first by Norway, the Netherlands and Australia in that order.

The deterioration of the NHS is just one example of the general deterioration of public services in the UK, particularly over the last 11 years of Conservative rule as a result of  their ideal of lower taxation, a smaller state, public austerity and the silly mantra of "doing more with less," allied to the dogmatic belief that publicly provided goods and services are generally  expensive, wasteful and inefficient, while private sector provision  is lean, efficient and effective.

If anything should dispel this nonsense once and for all it is the experience of unfettered "free marketeering" in the efforts to combat the Covid pandemic: the expensive PPE procurement  via favoured friends and ineffective test and trace system compared  with the superbly efficient vaccination distribution provided by the public sector.

When the ideologically focused but unnecessary regime of public austerity was implemented  by the Tories  from  2010 the NHS was supposed to be protected from the cuts.    However, given the obvious consequences of the increasing longevity of the population (full disclosure: I am a happy beneficent and hope to be costing the NHS above the odds for years yet to come) and the development  of increasingly expensive  treatments, it does not take a super-brain to realise that the health service (not to mention the care service) needs financing above inflation in order even to stand still.

In spite of boastful announcements from the government about apparently vast lump sums this has not in fact been received.  The NHS has experienced cuts and thus did not have the spare capacity to continue dealing  with routine treatments when inundated with Covid cases.

(Again full disclosure: I had to wait 16 months for a routine procedure which would normally have been performed within about three weeks, and I feel jolly lucky to have had it and not still be waiting.)

I have quoted these figures before but they bear repeating.

From pages 223/4 of John Kampfner's "Why the Germans do it Better"* (Atlantic Books 2020)

At the start of the pandemic:

  • Germany had 8.2 hospital beds per 1000 population, France 7.2, the UK 2.7
  • Germany had 28 000 intensive care unit beds, the UK 4 100
  • Germany had 4.1 doctors per 1 000 people, the EU average was 3.5  and the UK's 2.8
  • Germany had 13.1 nurses per 1 000 population, the UK 8.2.

The problems of underfunding are not limited to health care.  Social care has already been mentioned.  Our schools, playgrounds, public parks, child-care services, street maintenance  and nearly all local government services are stripped to the bone.

 Our failure to contribute only peanuts to the healthcare services, particularly in regard to vaccination, of the rest of the world is shameful.  I have no means of confirming  this, but I was told that  when the G7 met for their discussions in Cornwall earlier this year  there were more people vaccinated against Covid in Cornwall itself than in the whole of Africa.

 We cannot have a modern functioning  civilised country with the services everyone, and not just  those who can afford to "go private" deserve, without paying for it.  

And we need political parties bold enough to say so.


*  Kampfner's book is very appropriately subtitled: "Notes from a Grown Up Country."  It sounds condescending I know, but I truly believe that the UK electorate needs to grow up and stop being taken in by the false prospectuses of  boastful politicians interested only in their own advancement.


8 comments:

  1. It is ironic that our National Health Service, within weeks of being honoured by the award of the George Cross for its sterling work during the pandemic, should be downgraded from 1st to 4th place in the pecking order of developed countries' health services.

    Note that this is not a real drop. Last time that survey (by the Commonwealth Fund) was done, the NHS ranked second from bottom in the only measure that actually counts, healthcare outcomes; so much so that even the Guardian had to admit: 'The only serious black mark against the NHS was its poor record on keeping people alive.' ( https://www.theguardian.com/society/2014/jun/17/nhs-health ).

    The only areas where the NHS does well are in patient self-report surveys of their experiences, ie, warm-fuzzies that don't mean anything. In therms of what matters, the NHS was shit in 2014 and is shit now; there has been no drop in quality in the meantime.

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  2. PS — given your admiration for Germany, can I presume that you would therefore be in favour of abolishing the centralised, all-public NHS and replacing it with a health system modelled on the German one, which has mixed public and private provision of services?

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  3. Your first comment certainly puts a different slant on the report. Unfortunately the link you give says the page is out of date so I can't follow it up.

    As to your second comment, as a Liberal I certainly can't object to medical professionals offering their services privately and wealthy people jumping the queue by accepting it. However public provision should be sufficient to make private leap-frogging unnecessary.I gather that private provision is about 7% of the total in the UK, and that 11% of Germans have private insurance. Tthe two are not the same, but there does seem to be more private provision in Germany than in the UK. My ideal would be to make private provision unnecessary.
    Private provision in dentistry seems to have grown and grown at the expense of public provision without any democratic decision that this should be so. I believe this is most unfortunate.

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    Replies
    1. Your first comment certainly puts a different slant on the report. Unfortunately the link you give says the page is out of date so I can't follow it up.

      How odd; I can access it fine (there is a note at the top saying the page is more than seven years old, but as it was written on the release of the 2014 survey that is hardly surprising).


      As to your second comment, as a Liberal I certainly can't object to medical professionals offering their services privately and wealthy people jumping the queue by accepting it. However public provision should be sufficient to make private leap-frogging unnecessary.I gather that private provision is about 7% of the total in the UK, and that 11% of Germans have private insurance. Tthe two are not the same, but there does seem to be more private provision in Germany than in the UK. My ideal would be to make private provision unnecessary.

      I am not an expert in the German healthcare system, but my impression is that the private provision is not 'leapfrogging' but rather that the public and private hospitals work alongside each other.

      Of course as well as private providers of healthcare in Germany, the system is also unlike the NHS in that instead of being funded out of taxation, it is funded by compulsory insurance. Would you therefore, as you think the German system is so superior, support healthcare in Britain being taken out of tax funding (with commensurate cuts to the rate of national insurance) and instead have a German-style compulsory insurance system here? Or do you think the Germans have it wrong on that one? And if they do, how come their results are so much better than ours?

      Private provision in dentistry seems to have grown and grown at the expense of public provision without any democratic decision that this should be so. I believe this is most unfortunate.

      Presumably the shift has been driven by response to public demand; is that not a most democratic way of making decisions?

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    2. I have never claimed that the German system as a whole is superior, only that its provision of services is more adequate.There is no reason why we couldn't achieve similarly adequate provision by public finance if the parties campaigned for it.


      As to the demand for private dentistry, I think that arises from the shrinkage of public supply.

      Delete
    3. I have never claimed that the German system as a whole is superior, only that its provision of services is more adequate.There is no reason why we couldn't achieve similarly adequate provision by public finance if the parties campaigned for it.

      Has any country in the world ever achieved adequate provision by public finance? If not, then that suggests we can't. Whereas we have several examples of countries which have achieved good provision by insurance systems, Germany among them (Also France, Belgium… most of Europe in fact I believe).

      As to the demand for private dentistry, I think that arises from the shrinkage of public supply.

      Has anyone actually looked into which way the causation runs?

      Delete
  4. Your first comment certainly puts a different slant on the report. Unfortunately the link you give says the page is out of date so I can't follow it up.

    As to your second comment, as a Liberal I certainly can't object to medical professionals offering their services privately and wealthy people jumping the queue by accepting it. However public provision should be sufficient to make private leap-frogging unnecessary.I gather that private provision is about 7% of the total in the UK, and that 11% of Germans have private insurance. Tthe two are not the same, but there does seem to be more private provision in Germany than in the UK. My ideal would be to make private provision unnecessary.
    Private provision in dentistry seems to have grown and grown at the expense of public provision without any democratic decision that this should be so. I believe this is most unfortunate.

    ReplyDelete
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