What would the NHS see if it looked in a mirror, asks Siva Anandaciva, author of the King’s Fund’s study comparing the health service with those of 18 other rich countries, in the introduction to his timely and sobering 118-page report.
The answer, he says, is “a service that has seen better days”.
That, to put it mildly, is a glaring understatement. One columnist has described the service’s problems as a “perma-crisis”. The NHS is commonly described as “broken”, though by that some are referring to its funding model rather than its chronic lack of staff, its worryingly dilapidated estate and, especially, its abysmal record on providing urgent care. Public satisfaction is at its lowest ebb since polling began 40 years ago.
One NHS official recently contrasted the low-key public celebration for the service that we will see when it turns 75 early next month with the huge acclaim when it hit 70 in 2018. When asked why, he said it was because the service had really gone downhill in the past few years and everyone knew it.
The King’s Fund’s analysis underlines that. While affection and support for its founding principles remain undimmed, the care that patients often receive now is not good enough. “We are not by any means where we should be”, says Anandaciva.
Recent reports from the National Audit Office and Institute for Government have detailed the NHS’s implosion in unsparing detail, as highlighted most conspicuously by its inability to meet its main waiting times targets – for A&E, surgery, cancer care and ambulance arrivals. These were met, by and large, until 2010 but performance began to deteriorate sharply in 2014.
Delays in seeing a GP, getting help in an emergency department and having a new hip or knee that with luck will restore mobility, as well as long waits for paramedics to attend a heart attack after a 999 call, are depressingly well known. The human cost is anxiety, pain and – sometimes – avoidable death.
All are consequences of the NHS’s striking lack of resources – beds, scanners, staff – relative to similarly well-off nations, that the new report lays bare.
Anandaciva goes further, though. He identifies historical underfunding and longstanding staff shortages as important reasons why people in the UK with cancer, or who have a heart attack or stroke, are more at risk of dying as a result than their peers in most of the other 18 nations. Political neglect of such a vital asset as the NHS has a real-world human impact, measured in a greater likelihood of death from treatment delays.
Martin McKee, a professor of public health at the London School of Hygiene and Tropical Medicine, says: “The underlying health of the British public has suffered considerably since 2010, when austerity began. The NHS is picking up the pieces of failures in government policies and the shredding of social safety nets.
“We’ve seen a child dying because of mould on the walls of their home, the rise in food banks and more parents not being able to give their children nutritious food. The appallingly high levels of avoidable death from our big killer diseases are inextricably linked with austerity and underfunding of the NHS.”
Anandaciva says in his conclusion: “It should be a serious concern for political leaders and policymakers that the UK health system continues to fall behind so many of its peers on healthcare outcomes.” But that does not mean that the NHS model is broken, he adds. The evidence is that health services, whether organised like ours or not, perform better when they have the money, equipment and doctors and nurses to do their job properly. In a highly detailed 118-page report, that simple truth emerged clearly.
