The doctor won’t see you now ‒ Britain’s cost-of-surviving crisis
There is no shortage of grim headlines in Britain right now. The country is facing catastrophically high living costs, a steady drumbeat of strike action and potential blackouts this winter. So, here is another cheery thought: the breaking point for this government may be a cost-of-surviving crisis.
A certain amount of pain from rising energy prices can be absorbed with the appropriate level of government intervention and messaging — granted, neither are yet in evidence. Britons can invoke the “spirit of the blitz” to turn down the heat in cold months, don an extra layer and run fewer cycles of the washing machine. But hell hath no fury like a population that cannot access healthcare.
The prized and troubled National Health Service now has a backlog of 6.6 million patients waiting to see GPs, get scans or have operations. Liz Truss and Rishi Sunak, the two candidates vying to replace Boris Johnson, have both pledged vaguely to address the issue, but they have spent most of the campaign arguing about tax cuts.
The backlogs aren’t new. Even before the pandemic, the queue stood at 4.43 million waiting for care. Despite some recent progress, there is still a huge way to go. The number of patients waiting more than a year for treatment has grown by 13 times, according to the British Medical Association. In 2012, less than one fifth of people said they struggled to make an appointment at their GP’s office; now it is 47 per cent. More than a quarter avoid making an appointment at all.
More people are dying because they cannot get timely care. Ambulance response times have been some of the highest on record — and that’s before the real crunch of winter hits. Victims of heart attacks, burns and other emergencies are not being treated in humane or reasonable time frames.
Then there are the countless stories of people living in excruciating pain for months or years while waiting for a hip replacement or a diagnosis. The near impossibility of getting NHS dental care has led some to resort to extreme measures to get relief.
The lack of cancer care is particularly devastating. One in two people will develop some form of cancer in their lifetime. In my immediate family, I’ve seen three cases in the past decade or so. In my friendship group, there have been several. Caught early and treated well, survival rates for many cancers are highly encouraging. But while Britain’s cancer care has improved in recent years, it has long lagged behind other leading countries in one and five-year survival rates for many major cancers.
In Britain as elsewhere, Covid wreaked havoc on cancer diagnosis and treatment. Doctors now say the waits for both are at disastrous levels, and many people will die as a result.
The country’s healthcare problems have been made worse by workforce shortages. Across the NHS, there are 110,000 job vacancies. England alone urgently needs 12,000 more hospital doctors and about 50,000 nurses.
Burnout is a huge problem, with more junior doctors leaving before completing their training and more doctors retiring early, moving into private practice or planning to leave. Nearly one in five nurses who have left the job cited job pressures or stress as the reason. Brexit has also reduced the numbers of European Union-trained nurses and doctors in Britain, leaving hospitals to recruit from farther afield.
All of this doesn’t even touch on social care — the fragmented and underfunded system of support for everything from autism to dementia to other long-term needs. The 1.5 per cent increase in the national insurance tax — a social security tax — paid by employers and employees was billed as funding for social care, but its immediate purpose has been in trying to make a dent in the NHS waitlist. Truss wants to reverse it anyhow. Funding a proper social-care plan will likely require about 0.5 per cent of GDP, but no Tory candidate has committed to that.
Like the cost-of-living crisis, the healthcare crisis requires both immediate and longer-term solutions. The immediate challenge is getting people who need care into the system before delays add to pain and cost more lives. The only answer there is the obvious one: more funding and more workforce recruitment from outside Britain.
It will also require more contracting with private sector healthcare providers, as was done so successfully in many places during the pandemic to alleviate pressure on NHS hospitals. The dirty little secret of Britain’s state system is that it would collapse without the private sector, which has provided excellent services in orthopaedics, audiology, ophthalmology and other areas.
Both Truss and Sunak talk about boosting economic growth, but that will not happen without fixing these NHS issues. Long waits for treatment compromise productivity as well as quality of life.
Yet throwing ever greater sums at the NHS is both unsustainable and incompatible with the conservative vision of a lower-tax state. There is a need for longer-term solutions.
There are alternative models of universal health provision in other countries — such as those in the Netherlands and elsewhere that use public and private insurance to deliver high-quality care. That so many Britons who can are dipping into their disposable income to pay for private care suggests a willingness to make tradeoffs. Asking people to pay a nominal charge to see their GP — with exemptions for the poor — would likely reduce missed appointments and superfluous visits without materially impacting household finances. And it would help to fund more complex needs such as cancer care.
Any real solution will entail compromises, both financial and political. As one friend put it to me, Britain’s NHS is like the old Soviet economy: anything you do to fix it will almost certainly shock it into non-performance. Even so, non-action is akin to killing the patient, as well as any hope the Tories have for winning the next election.
• Therese Raphael is a columnist for Bloomberg Opinion covering healthcare and British politics. Previously, she was editorial page editor of the Wall Street Journal Europe