I recently asked two wise doctors, senior in their profession, what was wrong with today’s NHS. Was it money? Was it recruitment, or pay, or structure? Without consulting each other, they answered what was wrong in one voice: “Us.”
Tales of NHS woe flow almost daily. Britain is now ranked 30th out of the 49 richest OECD countries for infant mortality, with matters getting worse, according to the Academy of Medical Sciences. Meanwhile, surgical waiting times can stretch to five and a half years in Northern Ireland, according to the Royal College of Surgeons. The Times health commission this week found an NHS in digital chaos, with “between 40 and 60” types of patient records and 10% of hospitals still entirely paper-based. It wants a nationalised care system, a sugar tax and “health passports”.
Those who have spent time banging their heads against NHS reform will find little new here. Margaret Thatcher and John Major tried to upheave the NHS on multiple occasions, including through devolution and the “marketisation” of GPs and hospitals. All failed. They simply increased the bureaucracy, egged on by management consultants. Costs soared under Tony Blair and Gordon Brown. Nothing seemed to improve. This week, Rishi Sunak admitted he had failed totally to shorten waiting lists.
Most prominent public services are facing an efficiency crisis. The worst afflicted – medicine, the courts, the universities, the armed forces – are built around deeply conservative professions. But consultants, barristers, professors, colonels never blame themselves. While Britain’s trade unions have seen decades of reform, the professional unions have resisted all change. They are adept at escaping both blame and reform. When two medics debated the NHS on Monday’s Today programme, they comfortingly agreed that its failings lay elsewhere, in obesity and child poverty.
Of all the industries nationalised by Labour after 1945, the NHS is the most riddled with restrictive practices, guarded by an iron shield of public affection. Last month’s launch of Pharmacy First, allowing chemists to offer simple drug treatments and thus save 10m GPs referrals a year, took 20 years to achieve. As for the rule that you have to be referred by a GP to see a hospital doctor before a cancer scan, it must surely be the cause of Britain’s poor cancer record.
Medical training is still medieval. The collapse of British dentistry results from the profession requiring five years of mostly irrelevant study followed by two of “supervision”. Recent hospital militancy has its roots in the longstanding exploiting of “junior” doctors by consultants, and in the subordinate status accorded to senior nurses, largely because most are women.
The Heath government’s 1974 centralisation of local clinics and health centres wiped out the last shred of local government healthcare. It put GPs and A&E doctors in absolute charge. It meant that for children and elderly people, curing illness – not sustaining wellness – became the NHS’s sole concern. Care of elderly people vanished below stairs.
Labour’s shadow health minister, Wes Streeting, is likely soon to take on this burden. As have many before him, he has breathed the language of reform. He should look for lessons abroad and from the UK’s now booming private sector. But the first question he should ask is: why have all his reformist predecessors fallen at the first fence?
The answer is he must go where none has dared. He must confront and restructure the medical profession. Otherwise nothing will change, nothing at all.
Simon Jenkins is a Guardian columnist
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The alternative manifesto: Securing the future of the NHS
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