Chris Lancelot: Has the NHS had its day?

Is the NHS outdated? MEP Daniel Hannan thinks so, and incurred instant opprobrium from the government, the Conservative hierarchy and the BMA. To many, the NHS is clearly sacred and inviolable.

Which is a pity. What other mid-20th century institution has stayed still? Roads, shopping, communications and transport have all moved on since the 1940s: now we have motorways, superstores, mobile phones and the internet. Is the NHS really so perfect as to be unchallengeable and unalterable?

Let's put aside political doctrine and look at the facts. The overall concept of a health service free at the point of need and paid for out of general taxation has a lot going for it, and is one to which generally I subscribe. Nevertheless, the structure of the NHS itself contains inherent weaknesses.

The biggest problem is that people don't value what they don't pay for. This is why there is such a demand over self-limiting illnesses, so many DNAs and such emphasis on 'my rights'. There is no psychological incentive for individuals to manage carefully their use of NHS resources: no wonder demand seems to expand exponentially.

Partially because of the absence of such self-correcting controls the NHS requires a large bureaucracy to manage it - and the bigger the bureaucracy the greater the potential for inefficiency. The NHS may be good for patients, but it is truly awful for those working in it - bullied by politicians and often constrained by clueless managers.

But what are the alternatives?

Would you really work for an organisation where financial managers control clinical activity? Where patients are barred from a variety of treatments unless they can pay? That delivers services which vary according to where the patient lives? No, I'm not talking about the USA - this is the NHS, here and now.

So my advice is: let us all take off our blinkers and be rational and objective. The NHS is not the only way to provide universal healthcare: other countries have better outcomes (France) or more efficient financial arrangements (Singapore). The NHS may be fine in theory, but if the outcomes don't match the rhetoric then a careful, impartial reappraisal is needed, whatever the political pundits may say.

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