The Institute of Economic Affairs has today published my book: ‘Sixty Years On: Who Cares for the NHS?’
Significantly, the study lays bare for the first time the private views of a large number of the country’s most senior health politicians, policy advisers, academics, journalists and professionals.
Containing a series of devastating blows to the NHS as it prepares to celebrate its 60th anniversary, the research shows that when speaking off the record a substantial majority of Britain’s health elite no longer believe in nationalised healthcare.
Instead, an overwhelming majority accept a much greater role for private provision - including private hospitals, clinics, GP services and dentists.
While the NHS is itself now charged with being ‘inequitable’, ‘two tier’, ‘rationed’ and ‘costly’, a majority also believe it is too ‘monopolistic’ and want to see a much greater role for private funding arrangements - which could include personal health savings accounts.
Looking at private funding arrangements versus the state, an overwhelming majority of respondents surveyed (65%) believe that because people’s healthcare is unpredictable, some of its costs will increasingly have to be covered by private sources: ‘government arrangements such as taxation cannot do it all’.
One of the most telling responses to the survey was a question about statutory restrictions on advertising. From the beginning, an important aspect of the NHS has been the use of restrictive practices to reduce information flows to consumers of healthcare – ostensibly for their own protection.
It is clear that opinion formers simply do not believe this justification. An overwhelming majority of the sample – 81% - regarded Treasury Ministers as having the most to gain from the statutory restrictions on advertising because its promotes consumer ignorance. In other words, the banning of advertising of pharmaceutical products is perceived as a measure designed to keep patients in the dark so that they do not demand expensive drugs. This is significant in light of the current controversy about NHS patients not being allowed to purchase additional drugs.
Overall, the results show that the world has dramatically moved on from the 1940s. Opinion formers are now much more aware of the in-built failures of the NHS. As people’s expectations increasingly outpace what the state can deliver, and as nationalised healthcare loses the battle for hearts and minds, behind the scenes opinion formers are starting to seriously consider market alternatives. Already, in many of their minds, the NHS is dead. They won’t go on the record and say as much, but that is privately what they think.
While in 1948 the NHS promised to provide “all medical, dental and nursing care”, today some 25 million people are again going private for various forms of healthcare. 7 million people have private medical insurance. 6 million have private health cash plans. 8 million people pay privately for complementary treatments. More than 250,000 privately self-fund each year for private acute surgery, more than one 1 million people during the life of a Parliament, and many millions more pay privately towards long-term care. This is not to mention a whole raft of other NHS services - such as NHS dentistry - that are collapsing before our eyes.
If the government now allow private top-ups for medicines and treatments without precluding people from the NHS they will only do so because they are playing catch up with what the public have long come to accept as reality. As such, this book illustrates what ordinary members of the public have known for several years. The NHS is no longer a dearly loved British institution. It is a Stalinist nationalised embarrassment that should now be quietly and deftly consigned to the dustbin of history.
Sixty Years On: Who Cares for the NHS? is available from the Institute of Economic Affairs, price £10:
Alternatively you can download the text here.
