Joyce McMillan: Don’t believe hype over our NHS

The NHS is one of the world's most efficient healthcare systems, despite what some say. Picture: Getty Images
The NHS is one of the world's most efficient healthcare systems, despite what some say. Picture: Getty Images
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There are those with vested interests who would seek to undermine our right to free healthcare, writes Joyce McMillan

THREE years ago, courtesy of Lothian NHS and the Golden Jubilee Hospital, Clydebank, I received a total knee replacement operation that has been so successful I can scarcely believe the difference it has made to my life.

I spent nine days in a sparkling new hospital with spacious private rooms and pleasant views over the Clyde. I experienced state-of-the-art orthopaedic surgery worth something between £10,000 and £20,000, at no cost to myself, beyond a lifelong commitment to paying my taxes.

I don’t say that my experience of the NHS has always been perfect; indeed, in the eight years between my first knee collapse and my surgery, it would be hard to describe the functional uselessness of the NHS, in helping me to cope with such a chronic problem.

Yet when the moment came, and I knew that it was a question of surgery or a wheelchair, I experienced something that the anti-public healthcare lobbyists of the United States would have us believe is essentially impossible: world-class treatment completely free at the point of delivery, with absolutely no financial anxiety to add to the stress of a major operation.

In the US, 62 per cent of bankruptcies are associated with healthcare costs, and particularly with cancer diagnoses. From where we stand in the UK, 65 years on from the founding of the NHS, it is almost impossible to imagine the cruelty and barbarity of a system which adds to the most shocking and frightening moment of any life – the moment of a potentially fatal diagnosis – the near-certain knowledge that illness and pain will be accompanied by huge financial stress.

Nor does health insurance, for those who can afford it, remove that anxiety. Many of those declared bankrupt in the US had what they believed was adequate health insurance, until they actually needed to draw on it.

And it’s this context that always floods into my mind, whenever the debate over the future of the NHS reappears at the top of the political agenda.

There is no question that NHS failures need to be exposed, as in the huge Mid Staffordshire healthcare scandal recently examined in the Francis Report, or in the questions over the manipulation of Scottish NHS waiting lists raised in The Scotsman this week. No system can thrive by encouraging blindness to its faults.

Yet the truth about the UK’s healthcare debate at the moment is that it is almost impossible to enter into it without creating opportunities for the very people behind that indefensible American system. The corridors of power at Westminster are stiff with lobbyists from assorted private healthcare outfits, including the one whose boss made a large donation to the constituency re-election campaign of the former UK health secretary Andrew Lansley, during the last general election.

Both the House of Commons and the Lords – and indeed the Cabinet table – feature a startling number of members with declared financial interests in private healthcare companies, and it is arguable that the pervasive presence of those companies at Westminster represented the key moving force behind the passage, last May, of the notorious Health And Social Care Act 2012, which enacted a huge new reorganisation of the English NHS – along lines which greatly increase the scope for private providers – despite a complete lack of public support for such a change, and categorical manifesto assurances from both coalition parties that no such “reform” was planned.

And under these circumstances, every time we hear of an NHS failure, it immediately becomes grist to the mill of those who want to see the NHS’s “state-run monopoly” broken up, even though many of the worst problems seem to have been caused by previous market-style reforms, and the climate of competitive managerialism they created.

Positive NHS stories naturally receive far less coverage, and it would be hard to tell, from the general backbeat of negative debate, that the NHS is in fact not only one of the world’s most comprehensive healthcare systems, but one of the most efficient, in terms of care provided per pound spent.

All of which is unfortunate, for there are many debates we need to have about the healthcare of the future, notably about the profound negative impact on our health, and on health costs, of other areas of policy, including the promotion of car transport over healthier means of getting about, and the highly topical processed food industry, which has also scored huge lobbying successes, in persuading politicians to let it continue selling us high-calorie foods of poor nutritional value. There are millions of people in Britain who continue to defend the idea of the NHS, and who would love to be part of a constructive and searching discussion about its future. Here in Scotland, the SNP government repeatedly insists that it will defend the Bevanite principles on which the NHS was founded. And only this week, a Daily Mail journalist who posted a message on the UK mothers’ network Mumsnet, seeking material for an NHS-bashing story, was all but run out of town by the assembled online mothers, who fell to offering the journalist help in finding a less morally shabby line of work.

Yet most of us, if we are truthful, think of the NHS only when we need it, whereas those who are hostile to it are on the case all day, every day. They circle, they prod, they finance, they seduce, they sponsor conferences. They promote the Orwellian use of the word “reform” to describe regressive changes. They rely on the NHS to make the occasional big mistake… and they wait. And so long as they remain in our political waters, real debate about the future of the NHS remains painfully difficult.

For at heart, these big beasts of the health debate do not share our common vision of the NHS. They reject what 90 per cent of the British people support. And they have already demonstrated that, tiny minority or no, they are immensely skilled, persistent and powerful in eroding our dream-made-real of free healthcare for all; and in seeking to return us to a world that our parents and grandparents thought they had left behind for good, back in the summer of 1948.