The National Health Service was founded over 60 years ago and was intended originally to meet the needs of Britain in the immediate post-war period. Not only did it seem to cover the crippling costs of the new political situation, it seemed to demonstrate the same spirit which the British people had entered into during the course of that war. It was publicly financed, publicly run, and it was intended to pay for itself. None of these grand aspirations have been met, and the service itself is now a shallow husk of the great promise it used to embody. For these reasons I believe that it is time for a radical re-evaluation of what the NHS means and its place in society; we cannot afford to be timid or meek in this endeavour.
When the post-war Labour government created the NHS, it did so against the stated wishes of the British Medical Association. Doctors did not want to be the pawns of politicians; they saw their independence and effectiveness under threat from the new arrangement. They liked being independent; rejected the possibility of becoming the medical wing of the civil service; and made many complaints – notably the idea that the NHS would become economically inefficient as a result of frivolous consultations and appointments – about the prospects of the new service. In the end, Labour’s Health Secretary, Bevan, had to ‘stuff their mouths with gold’ simply to get the doctors on board. As time has progressed the doctors themselves have found their very livelihoods increasingly under threat from politicisation; targets were introduced in the Blair years which, though they did increase standards in hospitals, made health professionals the playthings of those in power. Top-down reform – a worrisome subject – has been approached successively, and bungled, by government after government.
First there was the IT scandal in the Labour years; it was estimated to have cost billions of pounds and achieved little of value – and those who were responsible came not from the ranks of doctors; instead, it was the managers who decided the reform was necessary. Then came the introduction of Primary Care Trusts, which have been seen by many to have been thoroughly inefficient. They have been largely replaced, but a great deal of the NHS is not up to scratch – especially in Wales, which has the highest waiting times in the UK and the most inflated mortality rates for hospitals in the country. The Trusts were replaced, with their place being taken by the Coalition termed ‘doctor-led’ healthcare. That this reform was undertaken in the face of heavy criticism from the medical world shows how detached from the wishes of practitioners the Health Service has become. (And the fact that these reforms claimed the career of one Heath Secretary and could well claim more shows that though doctors are now increasingly servants of politicians, they are not without some political skill themselves. It must however be accepted that the politicisation of heath in any case is not a victory, either for patients or those providing healthcare.)
The NHS does indeed need to be run by doctors, be more responsive to the needs of patients and open to much more competition, as this reform would truly reverse the increasing and adverse politicisation of the NHS, which has done it immeasurable harm and contributed to its being little more than a matter for political football. (In illustration, it must be remembered that the 2015 general election saw a bidding war in which the parties competed over which would give most money to the NHS, and that the Labour Party made a specialty of declaring with regularity – and often arbitrarily – that the country had only a certain amount of time left to ‘save the NHS’. Since the Conservative government has taken power, the matter of funding has been quietly shelved, never again to disturb the light of day.)
An NHS lead by doctors would at once be open to more competition and more compassionate, for it is doctors who are linchpins of both aspects of our healthcare; it is they who prescribe medication and who decide which variety of needle to purchase, for example, while they are also often a visible presence at the bedside of individual patients. (On the matter of needles, an illustration may be drawn. The NHS currently stocks two types, one of which is newer and more efficient and less painful to use; with doctors in charge, it seems that this inefficiency could be minimised or cut out entirely – yet at the moment both types are stocked, largely due to the indecision, justified or not, of managers and their subordinates.) And it is likely that the increased competition from suppliers – both of material and temporary labour, such as can be exemplified in hospital porters – would have to compete harder, driving up standards and driving down costs if expected to gain the approval of doctors and not managers.
Competition appears to represent something of a dirty word when discussing the nation’s heath, and this is not without reason. After all, to think of a fundamentally compassionate sector in terms of profits alone might serve to diminish its humanity and the extent to which patients actually feel looked after. This would – at least on its own – represent a profound negative effect. But that is not how the world works, and occasionally devices or mechanisms which may not sound inviting and idealistic may be necessary for maintaining and increasing the prospects in the longer-term of a large number of people. If the introduction of more competition – through the creation of internal markets, say, or the institution of non-politicised targets which are overseen by practitioners – helps to make the NHS more efficient, more focussed and – it must be said – more effective at making people better, it deserves to be explored with all the seriousness of any other sensible policy suggestion.
An NHS run by doctors and open to competition would not be perfect, but it would doubtless be more efficient, more humane and more of a true National Health Service, one genuinely worthy of the powerful ambition of Clement Attlee and his contemporaries.
James Snell 