With budgets already stretched before the Covid pandemic, the additional cost pressures since heaped on health trusts across the country by double-digit inflation has brought the NHS closer to breaking point than at any time in its history.
Every passing day seems to bring bleaker news for the beleaguered service, with a seemingly endless rollcall of damning statistics and publication of official reports charting yet higher levels of institutional failure. If anything, the relentless flow of anecdotes of patient betrayal, breathlessly reported in the pages of local press, is more shocking.
In the past few weeks, we learned that a Covid-infected grandmother from Clydebank, with a high heart rate, was forced to wait almost 19 hours for an ambulance to take her to the Queen Elizabeth University Hospital in Glasgow; four patients waited more than 20 hours in the back of ambulances outside Royal Shrewsbury Hospital; GPs in Peterborough are now responsible for the care of more than 2,000 patients each; and Stockport NHS Foundation Trust is offering food bank vouchers to hospital workers struggling to get by on poverty wages.
Last week, as Scottish members of the Royal College of Nursing voted to strike for the first time, the Scottish Social Attitudes Survey revealed that two-thirds of Scots believe the standard of care in the NHS has fallen. In August, one in ten operations north of the Border was cancelled due to lack of resources.
Meanwhile, a British Medical Association survey found that 44 per cent of senior doctors are planning to leave their roles “in some capacity” over the next 12 months, while the Care Quality Commission, the independent regulator of health and social care in England, reported 132,000 NHS and 165,000 social care vacancies, meaning a workforce the size of the population of Newcastle-Upon-Tyne is needed to fix the logjam.
None of this is likely to lead to any significant change – at least not in the short-term. Traditionally, the response of politicians to complaints of a “crisis” in the NHS has been to throw more money at it, and right now there’s no money to spare. While both Conservative and Labour governments have previously toyed with reform, none has dared challenge the universally free, taxpayer-funded model upon which the health service was founded.
If there is a single, immutable reality of British political life, it is that the NHS is an untouchable shibboleth, and any party that says otherwise risks courting electoral oblivion. Even if there was a Prime Minister mad or drunk enough to suggest privatising the service, they need to travel to the ends of the Earth several times over before finding a private operator madder, or drunker, enough to take on the job.
Yet, there is a dynamic to NHS’s most recent failings which appears materially different to anything previously. The service has endured because there is an almost spiritual belief in its universality. People of all classes and backgrounds accept the same level of treatment as a right and consequence of being British.
Those principles have survived because NHS care, as well as being universal, was also universally excellent. That can no longer be said to be the case. The withholding of treatment for years is worse than receiving poor treatment and those who can afford to pay privately for a better service will inevitably opt to do so.
The most compelling argument against privatising the NHS has always been that the provision of healthcare should not be left to the vagaries of market forces. The irony of the current crisis is that those very market forces may now compel its demise. No matter how strongly we support the NHS, few of us will be prepared to wait months – or years – to have an ingrown toenail treated or a cyst removed if we can have it done privately, the following week, for a few hundred pounds.
While we may have been happy and willing in the past to pay European levels of taxes in return for a European-style health service, we’re unlikely to do the same for a US-style system. With the growing development of robotics and telemedicine, as well as an expansion of over-the-counter diagnostics, more of us are now seeking remedies, for a greater range of treatments, from our local chemist or private therapist or practitioner. By spending a small amount each month, we can now have more-or-less unlimited telephone or video access to a private GP.
More is being done online than was the case a few years ago. Much of it remains minor, but the direction of travel is such that, before long, more serious illnesses will be diagnosed remotely and by high street providers. If we can be diagnosed with prostate or breast cancer sooner, and treated more effectively, then the way in which the health service is configured and funded will no longer seem as important.
We may end up with something approaching a German-style model where a private service handles minor and routine complaints, while accidents and serious illnesses are treated by a publicly funded service, similar to the NHS, which is free at the point of delivery.
It’s unlikely the NHS will ever be wholly privatised, but we could see – slowly and over time – some of its more routine functions being taken over by private companies.
Even the most traditional religions are forced to adapt and evolve to remain relevant and the NHS is no different. How it responds to the current crisis will determine its role in treating the next generations of patients and whether they will regard it with the same reverence for another 70 years.
Ivor Campbell is managing director of Stirlingshire-based Snedden Campbell, a search company for the medical technology industry