I was using a sledgehammer and a wedge to split logs in the garage. Everything was going well until I misjudged my swing and instead of smashing into the wedge the sledge smashed into my foot. The pain was agonising. My wife drove me to the nearest hospital. Instead of being piled into a wheelchair and rushed off to A&E we were told to report to the receptionist to arrange payment for whatever treatment I might need.
At this point I should make it clear that my encounter with the sledgehammer happened some years ago when we were living in the United States, where they do things rather differently with their health service. The first question a new patient was asked was usually not: “What happened? ” but ”How you gonna pay?” And the reason I recalled it this week was, as you’ve probably guessed, the publication of a report that shows most of us are thoroughly fed-up with the service we get from our NHS. We feel trapped in a “toxic relationship” with the NHS. Our confidence has fallen to a historic low.
One obvious question arising from this is how to restore confidence. Is it time to accept that the NHS is no longer fit for purpose and even think again about the founding principle that it must be free at the point of delivery?
The survey that has laid bare our unhappiness with the NHS is not some politically motivated piece of dubious digging for dirt. The research was carried out for the British Social Attitudes Survey analysed by the highly respected King’s Fund and Nuffield Trust. Its devastating conclusion was that only a quarter of the British public believe that the health service is working. Public confidence is at its lowest since polling began in 1983.
Only 24 per cent of us said we were satisfied with it last year. This had fallen from 29 per cent the previous year. Before that, the lowest satisfaction level had been 34 per cent back in 1997 when Labour won a landslide election victory promising to “save the NHS”. And indeed by 2010 satisfaction was at 70 per cent. That was the highest ever recorded. Since then it has plummeted. Ten years later it had fallen by nearly a third. And then, of course, by early 2020 Covid struck. It fell five points alone in the year that followed.
It's not so long ago that the NHS was described as our national religion and we smiled indulgently at the notion. Clearly we are not smiling any longer. So what has happened to turn us against it?
More than half of those questioned in the survey said they believed there are not enough staff. Almost as many blamed that on governments unwilling to spend enough money. About a third said the NHS wasted too much money. And the effect of all that, according to the survey, is that we can no longer see a GP or get a hospital appointment when we need one. That is the single biggest complaint we have.
Fewer than one in three of us are satisfied with A&E and only slightly more with inpatient services (35%). But satisfaction with social care services is even worse. Barely one in eight of us believe we can rely on social services for ourselves or our loved ones.
Dan Wellings, part of the team at the King’s Fund which analysed the BSA findings, said the results were “bleak but should not be surprising after a year of strikes, scandals and sustained long waits for care”. The Patients Association said it was dismayed by the BSA survey findings. Years of mounting pressures on the NHS, and its increasing inability to meet treatment waiting times, have left its relationship with patients “severely strained”.
Wes Streeting, the shadow health secretary, said: “After 14 years of neglect, the NHS has never been in a worse state. Fewer than one in every four people say they are getting a good service, and who can blame them?
“Patients are waiting 18 months for an operation, more than a month for GP appointments and NHS dentistry barely exists any more. The Conservatives have taken the NHS to breaking point.”
A bleak picture indeed. And all the polling evidence suggests that we worry more about the state of the NHS than we do about any other service for which the government is responsible. And yet, it seems, we are not prepared to accept real root-and-branch reform. Above all, we are not prepared even to contemplate any compromise with the founding principle established by Nye Bevan back in 1948 that our health care should be free at the point of delivery. Nor that it should be funded primarily from taxation and available to everyone, regardless of how much we earn.
Quite the contrary. Half of the people surveyed supported raising taxes and spending more on the NHS.
But perhaps it’s possible to argue that money isn’t the problem. That is what the Health Department seems to suggest. It says the NHS will be receiving nearly £165 billion a year by the end of this parliament. That’s more than ever before. An increase of 13% in real terms compared to 2019.
Nor does it accept that waiting lists are a growing problem. Again… quite the contrary. It says: “Overall NHS waiting lists have decreased for the fourth month in a row and we’ve delivered on our commitment to provide an extra 50m GP appointments months ahead of schedule.”
All of which may be true but Dan Wellings, senior fellow at the King’s Fund and the author of the report, author, warns that, with the general election approaching, “political leaders should take note of just how far satisfaction with this celebrated public institution has fallen”.
The overwhelming majority of those surveyed still supported the principles of the NHS, with nine in ten saying it should be free at the point of use. Wellings said the national sentiment was encapsulated by one patient who remarked that I “love our NHS” but “it’s a bit of a toxic relationship”. And he added: “People don’t want to criticise it. They don’t want to be negative about something which has been there for them, for their families, from cradle to grave, for a long time. There’s still a huge belief in the institution.”
It's hard to argue with that, but equally hard to deny that the demands on the NHS are greater than they have ever been. Rishi Sunak acknowledged that when he appeared before the Commons liaison committee this week. When he was asked whether the upward trend of spending on sickness benefits was unsustainable for the public finances he replied: “Yes. The welfare system needs to be sustainable, so it’s important that we look at this.”
He said the proportion of universal credit claimants signed off unfit for any work had tripled in the past ten years, with more than 60 per cent of those undergoing work capability assessments now deemed too ill to look for a job: “I think most people intuitively would think that the country is not three times sicker than it was a decade ago. So that is suggestive of a system that isn’t working as intended.”
He also said: “Everyone who can work, I believe, should work, not just because that’s fair to everybody else and helps financial sustainability and gives them financial security, but actually because it can bring that purpose and dignity to people’s lives.”
The cynics amongst us might interpret that as Sunak suggesting an awful lot of people out there are – in the parlance of a bygone age – swinging the lead. If so, that case was lent some support by another health report published this week. It came from the Centre for Mental Health and the NHS Confederation and shows that the economic and social costs of mental health problems in England have more than doubled in the past 20 years. It estimates that poor mental health cost £300 billion in 2022 That’s twice the NHS’s entire budget in England.
Speaking again, Labour's shadow health secretary Wes Streeting pledged: “The last Labour government achieved the highest patient satisfaction in the history of the NHS. We did it before and we will do it again.”
But let’s assume a Labour government will not be able to “do it again”. What then? Are you one of those who will continue to regard as sacrosanct an NHS free at the point of delivery or might you countenance some compromise? Perhaps a modest fee (suitably means-tested) for an appointment at your local surgery? Or would you regard even that as the breaching of a sacred principle? The start of a slippery slope which might lead us to a system of insurance as they have in most European countries. In other words, the end of the NHS as we know it.
Or would you regard that as a price worth paying if it means that those who abuse the present system will have to think twice? And anyone who’s daft enough to bash his toe with a sledge hammer should grin and bear it? Or at least pay for his treatment!
Let us know what you think.
