It’s often said that the National Health Service is the closest thing Britain has to a unifying religion. If that is the case, then the faith of the population is being tested like never before,
With budgets already stretched before the COVID pandemic, additional cost pressures since heaped on health boards across the country by double-digit inflation have 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 roll call 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 the local press, is more shocking.
In the past few weeks we learned that four patients had waited more than 20 hours in the back of ambulances outside Royal Shrewsbury Hospital in England; that GPs in Peterborough are now responsible for the care of more than 2,000 patients each; and that Stockport NHS Foundation Trust is offering food bank vouchers to hospital workers struggling to get by on poverty wages.
In the same week, a British Medical Association (BMA) survey found that 44% of senior doctors are planning to leave their roles “in some capacity” over the next 12 months, while the Care Quality Commission (CQC) 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.
Meanwhile, the average wait for category two, 999 calls for an ambulance — including for chest pains and strokes — in England and Wales is now 60 minutes, compared with a target of 18 minutes. And in Scotland, throughout August, one in ten operations was canceled due to a lack of resources.
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 – until now.
This week it was reported that NHS chief executives in Scotland – one of four autonomous health service areas in the UK – have discussed abandoning its founding principles by having wealthier patients pay for treatment.
The prospect of the first ‘two-tier’ health service in the UK since its founding in 1948 is raised in draft minutes of a meeting of NHS Scotland health board leaders in September. They also discussed the possibility of curtailing some free prescriptions.
While Humza Yousaf, Scotland’s Health Secretary, sought to play down the reports – insisting NHS Scotland would stay publicly owned and operated and free at the point of delivery – the reports represent something of a watershed.
Yousaf’s comments were only to be expected. 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 privatizing the service, they would surpass 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 the latest spot in which the NHS finds itself, which appears materially different to anything in the past. Again, you need only scroll through some of the local press articles to discover that waits are longer, levels of basic care poorer and patient experiences grimmer than ever before.
Figures published by NHS Wales last week revealed more than 60,000 patients are waiting more than two years for treatment. Ian Hembrow, 53, from Maesteg, in Bridgend was told the waiting list for his urgent hip operation was four-and-a -half-years.
In Bonhill, West Dunbartonshire, 69-year-old grandmother Mary Travis has already lived in crippling pain for more than two years, waiting for a back operation to straighten her twisted spine. Earlier this month she was told that, despite being at the top of a waiting list, she could face a further, two-year wait.
The NHS 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 better service will inevitably opt to do so.
The most compelling argument against privatizing 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 Britons support the NHS, few will be prepared to wait months or years to have an ingrowing toenail treated or a cyst removed if they can have it done privately the following week for a few hundred pounds.
And while we may be happy and willing 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 people are now seeking remedies, for a greater range of treatments, from their local chemist or from a private therapist or practitioner.
By spending a small amount each month, they can 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 patients 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 be as important.
We may end up with something approaching the German health service 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 privatized, 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 hold it with the same reverence for another 70 years.
About Ivor Campbell
Ivor Campbell is the CEO of Snedden Campbell, a UK-based recruitment agency for the global medical technology industry. IvorIvor has been in a candidate search for more than 30 years. Prior to launching Snedden Campbell, in 2001, he held senior roles for some of the UK’s biggest recruitment companies. Fed up with men in grey suits, pointless KPIs and sharp practice, he decided to launch a new kind of retained medical technology search consultancy that would bring approachability to headhunting, where clients and candidates would be treated equally, and where nobody ever said ‘touching base’. He now spends his time meeting clients and delivering on projects around the UK, Europe and worldwide.