It’s claimed that the British have a sort of religious zeal for the socialist principles of the National Health Service which blinds them to its faults in reality. But it’s the other way round. Many Brits are suspicious of socialism in the abstract. But it is through experience of the NHS that they have learned to love its species of socialism in practice – being treated for childhood illnesses there, seeing elderly relatives cared for at their last, and never having to pay.
Why do we love the NHS quite so much? For all its faults, our health service consistently does better than those in comparable countries at one important thing: protecting people financially when they are ill. In other countries, the prospect of medical costs can put people off seeking help.
Not here, though. In Britain, you know one thing for sure: however bad it gets, even if you lose everything, you can still get your cancer treated, or your broken leg fixed. You won’t even have to fill out a complicated form, or wait to be reimbursed by some unforgiving bureaucratic body. You can just turn up. It’s a great safety net that stretches under the whole of society, and makes us all feel less anxious – even those who are rich. We might not think to ask for this sort of thing, but we like it when we have it. (Just before the NHS was founded, surveys on health reform found people generally did not like the idea of state intervention – only about a quarter were in favour of it.)
Last week, however, came a report that the length of waiting times – the prospect of having to wait for important operations, even cancer treatment – is pushing people into private treatment like never before. In the final three months of last year there was a 39% rise in people self-funding treatments, compared with the same period before the pandemic.
Many of these new customers are uninsured, and are taking out loans and resorting to crowdfunding to pull together the money. Health thinktanks are warning of a burgeoning two-tier system, where the poor have to wait for care while others get to jump the queue, often busting the bank to do so.
The problem with this is not necessarily the “two tier” bit, nor the growth of private care. Health care has always been a two-tier system, and those in the top tier don’t always get a better service when it counts. (It’s the same doctors and procedures, just not quite as stringently regulated.) Private hospitals are necessary, it can be argued – they absorb a crucial portion of the burden on the NHS (right now they are helping the government chew through the Covid backlog). Nor do they gut the NHS of its doctors, another common but misguided fear. Setting up a private practice is a risky business, which is why most doctors never go fully private, but instead fit the work around their NHS job.
The fear that the growth of private care will somehow politically undermine the NHS is also unfounded, I think. Even with the current exodus to private care, patient numbers are not going down, but up. There will always be huge pressure on governments to fund the NHS. And members of the new glut of private patients have been reported feeling guilty because they love the NHS.
The problem, of course, is that last week’s report was an unmistakable sign the NHS is failing. People can no longer rely on it to care for them if things get really bad – that’s why they are risking bankruptcy instead. When a system makes you wait dangerous amounts of time to get cancer treatment, or allows your illness to deteriorate into a chronic condition, you know you cannot trust it.
We are at risk of changing from a country where people at least don’t have to worry about medical bills, to one where they might have to choose between not heating their home and living with a dodgy knee for a year, or think about remortgaging in the middle of cancer treatment. Many won’t even have that choice – they will simply have to wait.
A two-tier system is fine when what the top tier are really paying for is private rooms and little biscuits with their tea, and the bottom one does all the essential stuff well. When the bottom tier collapses, it’s a disaster.
If that happens, and if the trend continues, the cultural shift will be enormous. A new pit of anxiety will open in the national stomach. We will fear poverty like never before – we will see desperate people prostrating themselves on social media for the sake of their health. There’ll be another sort of shift too. Brits currently approach heathcare with a gritty sort of stoicism – waiting their turn, trusting the system. What awaits, if that goes, is elbows-out consumerism – spending all you can and tapping up connections to get to the top of the list.
If you’ve ever tried going private you might have noticed a sudden change in mindset. You feel suddenly demanding (you’re a consumer) and suspicious (what are they trying to sell you?). You’re in control but you don’t know what you want (after all you didn’t go to medical school – they did).
Such a change would be particularly hard for us to cope with. The British national character – dogged, stoical, keen on fair play – was largely created by war propagandists in the late 19th century to convince Brits they were the sort of people who were good at putting up with things like war. But it came of age alongside the NHS. The NHS – scruffy but sound, insistent on fairness, keen on queues, leaving no man behind, with a whiff of Blitz spirit – is perhaps the only institution that represents us as we would like to be thought of. You could say it helped invent us. We can’t let it go.
July 24, 2022 at 12:51PM Martha Gill