A heretic speaks

Madeline Grant of the Institute of Economic Affairs has a guest spot in the Times. Presumably when they invited her they had an inkling of what sort of guest she would be. You really ought to buy a copy of the Times or electronic equivalent to read the whole article, but I hope that the following excerpts will give the general picture. She is metaphorically sitting with her boots on the coffee table, fag in one hand, her host’s vintage port in the other, keeping the party both appalled and entertained:

Let’s stop kidding ourselves about the NHS

… our public services are on track to become a Leviathan health provider, with only a few other minor functions attached. You might argue that this cycle of increased spending simply reflects Britain’s ageing population, but it hides some growing dangers.

Voltaire quipped in the 18th century that “where some states possess an army, the Prussian Army possesses a state”. Like Prussian military might, the NHS has embedded itself in our national psyche, consistently topping opinion polls of Britain’s best-loved institutions. Its cult status is spread on social media by people sharing personal tales and using hashtags such as #TheNHSsavedmylife, as if a publicly-funded service doing its job was somehow remarkable. Then there was the bizarre worship of the NHS at the 2012 London Olympics opening ceremony. Foreign visitors here, often with far superior health systems at home, regard our NHS mania with bemusement.

We could learn a lot from other countries. Australia offers free health cover for everyone but encourages citizens to top up these costs wherever possible. Most Australians are covered for all in-patient care and about three-quarters of GP care. The majority buy “top-up” insurance to meet the shortfall, while the state subsidises insurance premiums. Though public spending on health accounts for 9.3 per cent of Australian GDP compared to Britain’s 9.8 per cent, it outperforms us on almost every measure, including, most importantly, patient outcomes.

Sadly, given our worship of the NHS, it will be politically difficult to incorporate cost-sharing elements. But let’s at least admit that our centralised model is an international outlier and not, as is often claimed, the “envy of the world”. Even in Sweden, which the left regards as a socialist Valhalla, personal spending accounts for 16 per cent of total health expenditure, compared with 9 per cent in Britain.

Increased funding for the NHS must go hand in hand with reform of a system which favours bureaucrats over frontline staff. Despite a growing shortage of nurses, the number of managers on the payroll had risen by almost a quarter in four years. Our health service lags behind others in the uptake of new technologies — a report last year revealed it was “the world’s largest purchaser of fax machines”.

I liked that line about the fax machines. Sometimes a single dramatic example that encapsulates an issue can do more to change opinion than a page of statistics.