The NHS, we are used to hearing, is wonderful, infallible, ‘the envy of the world’, ‘the world’s best health service’, staffed by heroes – but struggling under increasing demand and starved of adequate funding.
In a public debate resembling a religious sermon, voices advocating a change of model from a state monopoly and those questioning if the service itself bears any blame for the repeated crisis, are drowned out by a chorus of indignant believers, from the Health Secretary down. Here, we debunk the persistent myths surrounding the relative performance and funding of the NHS.
The claim that the NHS is ‘the world’s best’ health service stems from a yearly report by the left-leaning Commonwealth Fund, where the NHS consistently comes out top amongst 11 developed nations. A brief look at the categories reveals a survey that is designed to flatter publicly funded, single-payer systems over insurance based systems.
The Institute for Economic Affairs highlights how the study seems to favour specific methods of health care delivery: ’One criterion by which the study evaluates the safety of healthcare is whether a doctor ‘routinely receives a computerized alert or prompt about a potential problem with drug dose or interaction’. On this measure, the UK performs superbly, while Norway and Switzerland perform poorly. But does this really mean that Norway and Switzerland are unsafe places when it comes to drug prescriptions? Or does it simply mean that in these countries, drug safety issues are handled in other ways?’
When the Fund accuses the US system of leaving a large number of adults unable ‘to fill prescriptions because of costs’, it omits to evaluate what care is actually available. In the NHS, rationing takes place in a quango (a government mandated administrative body mandated), not at the till in a pharmacy. Some expensive treatment may only be available to the rich in the US, but may not be available at all in the UK. How does that make health care in the UK better?
The only quantitative category, health outcomes, sees the NHS ranked 10 out of 11, but with the high scores in the other categories, this does not prevent a 1st place finish.
Alternative rankings are less flattering for the NHS. The Health Consumer Powerhouse ranks the UK 15th amongst European health care systems. The medical journal The Lancet scored the NHS 84.7 points out of 100 for a global rank of 30th. ‘The gap between what the UK achieves and what it would be expected to, given its level of development, is wider than in other western European countries’, according to Professor Martin McKee, who led the study. In 2015, in a damming report, the OECD labelled the NHS ‘average or disappointing’ compared to international benchmarks. And the facts are not on the side of the NHS. The UK ranks 15th of 19 comparable countries for infant mortality and a disastrous 30th in the world for ‘healthcare amenable mortality’ – mortality from causes that should not be fatal if effective health care is provided.Poor cancer care is regularly highlighted as a weak spot for the NHS. It ranks below the European (Euro27) average survival rates for all cancers, 2nd from bottom for pancreatic and lung cancer and bottom of for ovarian cancer.
We are constantly being told that the panacea for all the health service’s problems is more funding. And ammunition for this viewpoint is provided by international stats that over the years seems to have shown the UK lagging behind other wealthy nations in health spending. Hiding behind the claim that the system is relatively underfunded, apologists for the NHS need never confront questions of relative inefficiency and poor outcomes.
Over recent years, the figures seem to show that spending in the UK (public and private) accounted for just below 9% of GDP, lower than the EU-15 average of 9.7% (but in line with the OECD average). However, a different definition of health spending was adopted by the OECD in 2011 and in the UK, the Office for national Statistics belatedly followed suit in 2017. The new methodology includes more of what in the UK is categorized as social care, and using these adjusted figures, the picture changes. Health spend in the UK jumps from 8.7% (2014) to to 10.25% in 2019.
The UK is in fact spending above the EU average and slightly below or in line with countries we normally compare ourselves to. As the Health Foundation puts it: ‘Clearly almost 10% sounds very different’ and ‘the new definition will recast the debate from just needing more money to understanding how we can use resources better’.
In the UK public debate, the NHS is a sacred cow, a quasi-religious entity above reproach. As one would expect, in a debate based on emotion and unquestioning faith, data is cherry picked, facts get overlooked and myths evolve.
The NHS is far from infallible, far from ‘the best in the world’, and throwing more money at it is not the panacea it is widely believed to be. In fact it is a sub-standard, centralized behemoth with over 1.5 million employees. A critical debate about alternatives is long overdue. We have long advocated a market based approach to health care delivery, but the mere mention of ‘private’ is anathema to the average Brit, who continues to believe in the myths surrounding the health service. It is time to slaughter this sacred cow.