The NHS needs its Reformation

5 July 2008

The Spectator on reforming the NHS

The government has promised that from next year everyone aged between 40 and 75 will be offered an ‘MOT’ of their health. The patient most in need of a health check, however, was 60 this week: the NHS itself. To a limited extent the government has recognised the inadequacies of what for its first three or so decades tended to be called ‘the envy of the world’ by using the anniversary to publish the NHS Next Stage Review, written by Lord Darzi, a junior health minister and eminent surgeon. The document is less celebratory than defensive, effectively admitting that the patient has often become lost in an organisation which is one of the world’s largest employers after China’s Red Army. Sadly, much of what it goes on to propose will, in fact, entrench that very bureaucracy.

At the outset, one should recognise what is good about the NHS. The principle of universal healthcare for all, regardless of the patient’s ability to pay, caught the public’s imagination in the 1940s, gave institutional expression to the social solidarity of the war years, and remains dear to patients to this day. While Britain had some excellent hospitals in 1948, many founded with generous benefactions, getting into them was not easy for all. The foundation of the NHS happened to coincide with the introduction of antibiotics, which, combined with improvements in hygiene, sent infectious diseases in Britain into rapid decline.

It is no accident that the NHS survived the privatisations of the 1980s and is still supported by the Conservatives today. Nigel Lawson’s famous remark that the health service was the closest thing the English had to a religion was correct. Yet — to extend the metaphor — the flock is growing querulous at the management of the church. According to a YouGov poll in the Daily Telegraph this week, only 21 per cent look forward to any real improvement in the NHS; 78 per cent think there are too many managers; and 82 per cent believe that ‘a great deal’ or a ‘fair amount’ of money is wasted in the health service. If the NHS is a religion, it is badly in need of a Martin Luther figure and a root-and-branch Reformation.

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