So it appears that we do know how to sort out the NHS then. Privatise it:
Last week, Hinchingbrooke Health Care NHS Trust was named the top hospital in England, based on 12 indicators for ‘outstanding performance in high quality care to patients’. Hinchingbrooke, in Cambridgeshire, had been the only small hospital even to make it onto the shortlist in the 25th year of the annual CHKS Top Hospitals Awards. Yet the expert panel awarded it the coveted first prize ahead of such leading NHS foundation trusts as Guy’s and St Thomas’ and Chelsea and Westminster. But Hinchingbrooke is unique: it is the only NHS district general hospital to have been put under the control of a private company — the Circle Partnership, which is co-owned and run by doctors and nurses. In 2011, Hinchingbrooke was failing, having had three notices served because of ‘inadequate’ results in accident and emergency, colorectal and breast cancer treatment. But when the Conservative-led Government approved Circle’s bid to take over its running, there were dire warnings and howls of fury from the unions and the Labour Party. Unison declared: ‘This is a disgrace, an accident waiting to happen, putting patients at risk.’ Andy Burnham, the shadow health secretary, protested: ‘This is not what patients, public or NHS staff want.’
From possibly the worst hospital in the country, so bad that not even the State wanted to try and keep running it, to the best hospital in the country. Sounds like we'd do well to do more of this then. You know, more of what works?
There is more to this than just privatisation of course. While we might like to think so markets all the time nothing but markets isn't quite the best way to run the world. It's a useful guide, certainly, that our presumption should be that markets will sort everything out but it's not a strict rule that will guide us to the optmial end state. There are those times when we need to do other things: the trick is in working out what we should be doing and where we should be doing them.
With regards to the NHS it's worth thinking back to the various WHO reports on who has the best health care systems. Note how the ranking is achieved:
The rankings are based on an index of five factors:
Health (50%) : disability-adjusted life expectancy Overall or average : 25% Distribution or equality : 25%
Responsiveness (25%) : speed of service, protection of privacy, and quality of amenities Overall or average : 12.5% Distribution or equality : 12.5%
Fair financial contribution : 25%
There's an awful lot there that deals with the equity, or "fairness" of the system. And a system that is nominally free at the point of service should beat everyone else hands down at that sort of thing. Yet the NHS was only 18th even by these, very favourable to the NHS indeed, criteria for measuring a health care service. The reason being that while the NHS is very equal, it's not all that good. Mortality amenable to health care is dreadful as is speed of service.
So, what could be done to improve matters? Well, one idea is to take a leaf from the book of what the WHO regarded as the best health care service in the world, the French. Which is, roughly speaking (the French use an insurance system but it's so tightly bound with the tax system that it's not radically different) to keep the current tax based financing system but open up provision of services to anyone who wishes to do so. Charities, for profit companies, doctors' and workers' cooperatives (Circle being a combination of those last two), the State itself: why not have a vibrant ecosystem of providers?
As it turns out this is a very good idea: for we've maintained that equity and fairness in the provision of health care but the change in the system, from a centrally planned near Stalinist monstrosity to something approaching a market, has led to those very large improvements in the quality of treatment and the speed and responsiveness with which it is delivered. The best of all worlds perhaps.
Now that we know what we should be doing the only question left is why isn't everyone trumpeting this from the rooftops? It cannot be that some people would prefer health care to remain bad simply for ideological reasons, can it? It would be quite outrageous to suggest that any in our fair land are so blinkered as to do that.