Nothing like a night in hospital to force you to focus on funding for the NHS

The Health Secretary Wes Streeting was right when he made this diagnosis of the NHS last year. However, whilst Streeting might be the first in Labour to say it, he’s behind a host of Conservatives who’ve made the same prognosis.

Why am I thinking about this topic? I was going to write about the difficulty, in these febrile political times, of spotting an April Fool’s prank.

But no, it’s the NHS.

Consider this a despatch from the frontlines. Yes, those are my feet in the photo, in NHS issue non-slip DVT socks while I write this from a hospital bed.

Unexpected but rather routine. No life or death case, mercifully. The health service is, however, in worse shape than me. Watching the machine working in front of me has made me think more about that.

Because the NHS is a peculiarly British institution it is perhaps not surprising that we have a peculiarly British attitude towards it. Many have a general political view of what it is for, how it’s paid for and how it could be improved – to avoid the scenario we started with – and then, almost separately, their own personal experience of any interaction with it.

I’ve met people politically dedicated to it being entirely in public hands, funded by tax, who are aggrieved at how one bit of the NHS handled them or a loved one.

I’ve met people who’d want it moved to an American insurance model who can’t speak highly enough of the personal treatment they’ve received.

I mention these two political positions because, as I wrote here recently, the debate about how to stop the ‘health service with a country attached’ scenario coming to be, has been stymied by a determination to make it a false debate.

If like many on the left, you see the NHS as sacrosanct and not to be sullied by the infectious hand of private capital, then anything other than taxpayer-funded-forever system is to be attacked as akin to moral depravity and an agenda to make us, into America. A system few, even on the right, think ideal or equitable.

If like many on the right, you are uncomfortable with the NHS being seen as almost untouchably holy, treating it akin to the 2012 Olympic opening ceremony, or the more implausibly moralising episodes of BBC’s Casualty (drama it seems is the new ‘documentary’ don’tcha know?) then too often you are seen as more in favour of profiting off the sick, than in favour of real reform.

The truth is that the Britain and America models are not the only in existence. The debate need not, indeed must not, be stuck between two extremes. It already has been for too long and Covid rather squashed any mood to reopen and remodel that debate.

The sound of banging pots and echoing applause, that odd relic of the pandemic, may have helped drown out the voices calling for change and revealed that – far from the false choice in the UK/US option – there are hybrid models in many European and non-European countries, and the ones we should look at are those with the best health outcomes.

Not the cheapest, not the most comprehensive, but the ones that have the best results for patients.

We’re not great at that.

In the same way measuring GDP rather than GDP per capita gives a distorted reading, I’ve heard officials tell me that things have improved in branches of healthcare “because we increased the funding for it”.

But what were the outcomes? “Oh, well, that’s where the data gets a bit fuzzy.” With sums like these at stake, nothing should be “fuzzy”. Systems that measure success by how much is spent can only become a money pit.

To be honest my current experience of hospital fits the pattern of many for the NHS.

The nurses are polite and cheerful enough, but they don’t have time to run on much more than that given the large list of tasks they have. They are neither counsellor nor entertainers – they do seem to care, enough, and that’s really the point.

The volume of demand means patients do a lot of waiting, and not always with clear information; you can get passed from person to person until you feel like a unit, not a person yourself.

But if you accept all that and give in to it, then the process of being treated does eventually happen – and, like the Stones (kidney in my case), you can’t always get what you want, but they try, and you get what you need.

But adequate shouldn’t and needn’t be the ambition. I once asked a group of voters of different political persuasions that if treatment stayed “free at the point of delivery” (the NHS is of course not ‘free’) did it really matter who provided the care?

No was the general answer. It just got trickier when I asked about the balance of public and private they were comfortable with. Some worried about salami slicing health until it’s all private, while others worried that getting the mix wrong was a one-way ticket to the eternal money pit.

Last time I mentioned different health care systems, I was asked by a reader to look into models of healthcare I thought might be candidates for a template for reforming ours.

I will do, but more importantly I’d urge the Conservatives to look carefully at them as part of their policy homework.

We can’t be scared because we actually don’t have the time.

The National Health Service might be for some a hallowed national treasure, but it can’t be the Nation – and without real change, that’s what it’s going to cost.