Owen Paterson is a former Environment Secretary and former Secretary of State for Northern Ireland. He is MP for Shropshire North. He is Chairman of UK2020.
The National Health Service occupies a unique place in the public consciousness. Healthcare free at the point of use whenever it is needed is undoubtedly a noble cause, but it has become far more than a means of medical provision, and is regarded as a great cultural unifier – one of the supreme achievements of post-war Britain. As a result, it is rare for anyone in public life to suggest it is a bad or failing system; to take a critical tone toward the NHS is considered almost unpatriotic.
The orthodox view is that the NHS is the “envy of the world”, yet when I commissioned research from the think-tank which I chair, UK2020, into UK health outcomes in 2016 I found little evidence in support of that claim. The report used publicly-available data from international sources – the OECD, Lancet, Eurocare and others – for a range of conditions with binary diagnoses such as cancers and strokes. From this snapshot, it estimated that 46,413 people die in the UK as a result of not being treated by “the world’s best system” for their particular condition. Compared against the 12th best, that figure is 17,000 avoidable deaths.
The instinctive response from many reading this may simply be more money will solve the problem, but spending alone cannot be the sole reason for our poor performance. Countries which spend the same as us on healthcare or even less as a percentage of their GDP – Australia, Finland and Israel among them – still outperform us for various conditions, including common cancers.
Indeed, despite talk of “health cuts”, the last Labour Government increased healthcare spending each year, and the Coalition and now Conservative Governments have maintained that course. In 2005/6, per capita public expenditure on healthcare was £1486, and it rose to £2130 for 2015/16. As a percentage of GDP, it rose from 6.4 per cent to 7.4 per cent over the same period. Now the Government is providing an additional £10 billion of investment per annum in real terms by 2020/21, compared to 2014/15.
Of course, those figures do not reflect the increasing burdens placed on the NHS by a growing population and an ageing society. These pose a real challenge in the years ahead. Healthcare costs rise with age, so the majority of health spending represents a transfer from those of working age to the retired. Longer lives and lower birth rates thus threaten the present system’s financial viability.
Thus, the simple answer “More money!” will not do. It is laziness on the part of the Labour Party – unable to see beyond their blinkered, statist dogma – and cowardice on the part of Conservatives who are naturally against monopolies and prefer a pluralistic, consumer-focused provision.
Instead, we need a rational, level-headed debate about the future of healthcare provision in this country, setting out a vision informed by what we can learn from abroad. In other areas of public policy, we recognise the value of international best practice, yet our discussions of the NHS remain inward-looking and apparently stuck on the notion that it cannot be otherwise. It is almost as though we are afraid of what we might find out if we look beyond our shores.
In recent days, for instance, the discussion about Accident and Emergency delays has been completely insular, with apparently no thought for how other systems function. The NHS is the fifth largest employer in the world, yet recent studies placed the UK in the bottom category for both A&E delays and the general unavailability of same-day GP appointments. In a whole host of countries – Belgium, the Czech Republic, Denmark, Hungary, the Netherlands, Portugal, Switzerland – such appointments are the norm and A&E waiting times are typically under an hour. Surely, we have something to learn from them?
If we are serious about addressing the problems we face, these are questions we must ask. Over 25 countries in the world now provide universal health coverage, so we must put an end to this stifling misconception that the only alternative to our present arrangements would be a US-style system of private insurance. We can, instead, learn from the high degree of patient choice available in countries like Australia, Japan and South Korea. We can look at the so-called “social health insurance” systems in place in Belgium, Germany, Israel, the Netherlands and Switzerland. Such systems achieve universal coverage just as in the UK, but do so with a range of means-tested insurance premium subsidies, community rating and risk structure compensation. In so doing, they ensure high-quality healthcare is available even to the poorest, including the homeless. There is no uninsured population, unlike in the US where, even after Obamacare, 8.8 per cent of the population, or 28.1 million Americans, were uninsured in 2016.
Calls for the Government to set up a cross-party Royal Commission into the future of healthcare are, therefore, welcome. But a key part of any investigation must be to send health experts around the world, identifying lessons that can be learnt on funding and delivery to make the UK health system the best it can possibly be.
Discussions of the UK’s failings on health are difficult for anyone to hear, let alone for the 1.5 million people who work within the NHS with such dedication and skill. But it is surely for them, as much as for the health of our citizens who so depend on health provision, that we must have a truly open discussion about health delivery in which no ideas are off limits.
Much has been made of “Global Britain” once we leave the EU. To compete globally, we really do need a world-class health system. The future of healthcare is one area where we absolutely must embrace lessons from abroad.