The NHS debate


I made a couple of media appearances yesterday to discuss the National Health Service. One of the points I stressed in both was how dismayed I have been by the level of political debate that this row – kicked off by American criticism of the NHS – has engendered.

The fact is that while there have been some improvements in the last decade, the NHS is by no means "the envy of the world". Indeed, on a whole range of indicators – whether it's patient satisfaction, waiting times, preventable deaths, stroke and cancer survival rates, hospital acquired infections, or the uptake of new drugs and technologies – the UK lags behind other European and developed countries.

The health service is hardly cheap either. We already spend £100bn a year on the NHS in England alone, and that figure looks set to continue rising regardless of who wins the next election. To put it another way, someone earning £30,000 a year will pay £2,300 in taxes to support the NHS. We may spend less than the US, but we also spend similar amounts to our European neighbours and get much less for it.

Britain deserves a proper, grown-up debate about its healthcare. But what do we get? Politicians 'tweeting' about how they love the NHS, and accusing anyone who dares disagree of being traitorous and unpatriotic. This is not just cowardly and infantile; it is also dishonest, shallow, and quite frankly pathetic.

Rather than burying our heads in the sand, we need to realize that there is a lot to learn from other countries – like Switzerland, the Netherlands and Singapore, among others – that provide better healthcare than we do. The key is to take the best elements of various systems come up with a reform model that will work in Britain.

A successful reform would likely embrace two key principles. The first is that healthcare is far too big and complex to be run from the top down. The second is that whether you are relying on tax or insurance to fund your healthcare, you can't completely isolate people from the cost of care, otherwise prices spiral out of control. I'll return to both these principles in future blog posts.