Maybe the National Health Service (NHS) is a little wobbly, but still very stable.
Broken. Crisis. Breaking point. These are words that the media as a whole love to use about a variety of subjects, ranging from Britain as a whole, to the nation’s sandwich making capabilities. However there are very few subjects as talked about as the NHS in general, a world renowned British foundation; Universally loved among all. So with the recent statistics of the worst A&E waiting times since records began, visions are cast of hospitals unable to bear the weight of the a growing population, of the entire organization we hold dear on the verge of collapse and disarray. Undoubtedly words like broken, crisis, and breaking point have been used to describe the NHS by a variety of sources.
While the political side picking and various vested interests all squabble among themselves to blame each other, the main message coming out is that “Something Must Be Done”™. Some messiah must emerge, whether he be dressed in Red, Yellow or Blue, and lead the NHS out of the collapsing squalor that it will inevitably befall it. In reality, you have to call this “Poppycock”.
NHS A&E Crisis : The Statistics
The statistics and lessons to be learned from the facts must be placed into context of the system as a whole. In England during the week before Christmas 2014, the amount of people admitted to A&E who were seen within the target of 4 hours dropped to 83.1%, the lowest since records began in 2004, with the year average being 92% (Denis Campbell. (2015)). Already the alarmist nature of some in the media seems a little premature: While the drop is noteworthy and should be mentioned, a few percentage points dropped is a far cry from the 1980’s horror stories regarding patients being left for days on trolleys (BBC News. (2001)), or of a system that is disintegrating in front of our eyes.
Of course this isn’t something that should be disregarded entirely; Degradation of standards and results should always be looked upon with care – and more importantly learned upon. While many will point towards a fat lazy booze fueled aging populous, in reality the problems faced during that week is simple: The week period between 14/12/2014 – 21/12/2014 had a total of 289,530 patients: An increase of almost 9% over the same period in 2013 (NHS Analytical Service. (2014)). This is where the problems lie. An unprecedented increase in total required capacity is going to put unprecedented strain on the system. Hardly rocket science.
This in itself is interesting, and a very complicated issue to pinpoint. To the dismay of certain pint drinking politicians, “Something Something EU, Something Something Immigration” isn’t the answer: The population last year only rose by 0.63% (BBC News. (2014)), a far cry from explaining the increase. As much as Labour would like to blame the Conservative government for this (Perhaps Jeremy Hunt himself personally injured the additional 23,716 patients?), in reality the problem is a long term accumulation of mistakes by all political parties, of forces outside the NHS, GP contracts, changes made in 2004 and an societal inability to adapt to an aging population. This in itself is its own article.
How the NHS Healthcare System Compares Internationally
But in reality comparing what the NHS does with the rest of the world, even the worst of our statistics are impressive in themselves. The UK has a culture of self deprecation, feeling that the rest of the world is somehow “better ran”, and that these issues are UK specific due to England and the rest of the gang being “terrible at everything”. To some extent this is what makes the NHS great, with scores of targets and statistic generating to self improve, that a vast portion of the OECD countries don’t bother themselves with (Germany and America for instance both don’t measure the A&E waiting times.).
In cases where there are similar statistics to draw from, the NHS usually comes out favorably or even ahead. Last year the US-based Commonwealth Fund Survey ranked the NHS number one out of 11 health services in leading economies (Commonwealth Fund, 2014). This was done over 11 categories, the NHS being deemed the best in all but three of these groupings. Even though the methodology of the above isn’t a definite ranking due to the difficulty of comparing various healthcare systems, it does act as a useful benchmark. A and E waiting times are also an area ironically where the NHS is the strongest. Even after being hammered by a major increase in A&E admissions, the overall 92% of patients being seen within 4 hours would place the NHS far above the targets of Sweden (79% target, 68% actual), Canada (90% target, 89% actual), or Australia (75% target, 69% actual) (Gov.uk. (2014)).
Even in statistics the NHS has always lagged behind in, immense progress has been made over the last ten years. Cancer and infant mortality rates have dropped significantly, and general life expectancy has increased by three years. (It should be noted that these are bad benchmarks for comparing international healthcare systems, simply because of the hugely differing cultures and the healthiness of the lifestyles that perpetrate from these.), all the while getting bang for our buck compared with other countries spending per capita. Practically every measurable statistic has improved over the last 10 years of the NHS (Including the last 4 years), meaning that presumably if we’re currently in “Crisis”, then the NHS of 10 years ago must have been nothing but patients waiting generations to have that cough sorted out, nurses running around while literally on fire, and doctors meandering about with a coffee in one hand and a beating heart in the other – Trying to work out which one goes back into the patient.
NHS Political Factors
That of course isn’t the truth. The NHS was fine ten years ago, and has gotten better since then. There are issues and improvements to be had, but far from total destruction we are. In reality the current NHS situation is simply the politics of fear, fear to get the public concerned that the British institution that we all love and know will be no more. Unions and private consulting companies alike will claim the NHS is “broken” and can only be fixed by paying them and their members eleventy billion pounds. Interest groups will suggest that the NHS is “unsustainable” unless we remove the free at point of entry that is so enviable of our system. Labour will suggest that the NHS is “in jeopardy” should the Conservatives get back in power, that somehow the mere presence of the Tories will cause the earth to crack open and swallow it whole. The Conservatives will suggest that the NHS is at “Tipping point”, and under Labour will fall into the sea unless their spending plans are put through and more free market principles are applied. The Lib Dems will… say anything to remind us that they still exist.
Simply put however, the NHS has been on a consistent increase in standards over the last ten years. The Reorganizations, reallocation of funding and other current changes being implemented are par for the course, mostly due to the NHS being a highly politicized ball that each party needs to fundamentally change because “Something Must Be Done”™. Even with the huge outside pressures of greater usage and an aging population, the NHS still holds up and keeps strong. While improvements and changes are always upcoming and wanted, to call this a “Crisis”, is to fall into the politics of fear, and by doing so the hands of those who wish to change the NHS for their own benefit.
Denis Campbell. (2015). Hospital A&E waiting times hit worst level on record. Available: https://www.theguardian.com/society/2015/jan/06/hospital-a-and-e-waiting-times-worst-record-nhs-england. Last accessed 10/01/2015.
BBC News. (2001). Horrific’ waits at London hospital. Available: http://news.bbc.co.uk/2/hi/health/1308964.stm. Last accessed 10/01/2015.
NHS Analytical Service. (2014). A&E Attendances and Emergency Admissions.Available: https://www.england.nhs.uk/statistics/statistical-work-areas/ae-waiting-times-and-activity/. Last accessed 01/10/2015.
BBC News. (2014). UK population grows by more than 400,000. Available: https://www.bbc.co.uk/news/uk-27972335. Last accessed 10/01/2015.
K. Davis, K. Stremikis, C. Schoen, and D. Squires, Mirror, Mirror on the Wall, 2014 Update: How the U.S. Health Care System Compares Internationally, The Commonwealth Fund, June 2014.
gov.uk. (2014). International comparisons of selected service lines in seven health systems. Available: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/382847/Annex_5_AandE.pdf. Last accessed 10/01/2015.