Some on the right are using the current NHS crisis to suggest a different health system is required – but how much of this is built on fact?

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The NHS is in crisis. When I talk to people who have worked in it for 30 years or more, they have never seen a situation like this before and the next three months are going to be very tough.

The reasons are easy to understand. We have been through the worst pandemic for a century. On top of this, successive governments have failed to fix social care, which is having a disastrous impact on the NHS. But these reasons are no excuse to question the validity and efficiency of the NHS, like the right is trying to do as they reframe the service as being inherently to blame for this crisis – inferring that another system would work better. 

The Government was happy to clap nurses for their amazing work and dedication during the Coronavirus crisis but, just a few years later, it is refusing to negotiate with them about a salary increase that will make up for the erosion in their real wages – even though the majority of the public support their strike action. Its refusal to even meet to talk about their wages has led to the bizarre sight of the Royal College of Nursing negotiating with itself.

We are returning to the 1980s when the NHS was in a terrible state because it had been starved of money. And it was at this time that right-leaning think tanks talked about NHS staff being lazy and suggesting that an insurance-based scheme would be better, despite healthcare costs being responsible for 50% of bankruptcies in the US. Do we really want to go there?

That is why it’s worth exploring – and debunking – the myths about the NHS that are being disseminated as it stands in crisis.

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Myth: The NHS is a Bottomless Pit

The issue isn’t that the NHS is a bottomless pit but that, for the past 13 years, Conservatives Governments have not spent enough money on the NHS.

The core purpose of any government should be to maintain the health of the nation. Spending on health increases GDP and should not be considered in isolation. The pandemic has left seven million people on waiting lists but the Government’s failure to fund the resolution of this is leading to millions of patients (and the families who need to look after them) unable to work, depressing GDP. 

Since 2008, the NHS has faced an acceleration of demand due to an increasing and ageing population, even without the extra stress of the pandemic. But, over this period, the annual real increase in funding has declined from 4% to 1.5%. In 2018, a five years funding settlement for the NHS was agreed at 3.5% per annum for the years 2019 to 2024 but, as a result of the pandemic, this was reduced to 2.5% per annum.

This effects of this lack of investment were already evident before the Coronavirus crisis as the elective waiting list was already rising alarmingly, and vacancies were already running at 100,000. Now they stand at more than 130,000. Despite assurances, before the pandemic there were also major requirements for capital funding to repair hospital buildings and invest in IT.

The pandemic made things worse, but to blame everything on it is an error.

Spending on the NHS is not a bottomless pit – the Government has created a false bottom and is just not spending enough. Comparison with other countries proves this. The percentage of GDP spent on healthcare actually dropped from 9.8% in 2013 to 9.6% in 2017 and is the second-lowest in the G7, according to ONS Census of 2021.

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Myth: The NHS has Low Productivity

Although the Prime Minister has questioned the NHS’s efficiency, the data tells a different story.

A University of York study of productivity found that, between the fiscal years 2004/5 and 2016/17, the NHS showed a 16.5% increase in productivity versus 6.7% in the economy as a whole. 

A related myth is that the NHS is full of managers, not clinicians, and that this is ruining its productivity. But managers only make up 2% of the NHS’ workforce, versus 9.5% for the UK as a whole, including the Civil Service.

The NHS also comes fourth out of 11 healthcare systems for efficiency analysed by the Commonwealth Fund – so it is above average and not the low productivity case that many commentators on the right want to make out. Like all systems under extreme pressure, it is ‘running hot’ and many staff are burned out. With so many vacancies, the fact it is still has a working efficiency is a testament to its strength.

The danger now is that it is being pushed unrealistically to find increasing efficiencies by the Government by initially increasing required savings from 1.1% to 2.1% and now to 4%. The risk is that this will put too much emphasis on cost saving at this challenging time, especially as the required saving is £4.75 billion with no plan to achieve it.


Myth: GPs Do Not Work Hard Enough

In May 2020, GPs delivered 27.5 million appointments in one month alone – 18 million of these face-to-face. Even with increasing workloads, 56% of patient respondents in recent surveys said they had a good experience with their GP.

However, demand is outstripping supply because there is a shortage of GPs, even though there is an increase in GPs in training.

Whatever the Government says about there being more doctors and nurses, there are still not enough, hence the large number of vacancies. In fact, there is a shortage of 4,200 GPs in permanent roles despite more in training. Many experienced GPs are also leaving because of burnout – a consequence of under-funding the NHS and ‘running it hot’.

There are some simple steps that could be made to encourage more medical students to become GPs. Their exams, for instance, are very expensive (one costs £1,800) – the Government could pay these with a contract that the examinees undertake to stay in post for three to five years. More could also be done to enable flexible working. 

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Myth: The NHS is Being Privatised

The private sector has always partnered with the NHS since its inception – this has been particularly the case for dentistry and ophthalmology. It makes sense to commission the best IT in the world instead of trying to cobble something together in-house and there are other areas such as radiology where private partnerships make sense.

However, the private sector accounts for a much smaller slice of the NHS budget than most people think. In 2021, it only accounted for £12 billion out of the NHS’ total £100 billion budget. 

During the pandemic, many more private partnerships emerged but these were commissioned directly by the Government, mostly without competitive bids. Track and Trace at £32 billion was the largest of these, even though the Government decided to use NHS branding. The value for money of these commissions is questionable to say the least and the ‘VIP lane’ for the awarding of PPE contracts – which Byline Times led the way on in reporting – seems to have been widely abused. But, again, none of this was commissioned by the NHS.

Importantly, the NHS remains free to access and available to everyone, but it is not a free service – we all pay for it in our taxes. Paying for it is both a selfish and altruistic act. Until now, it has been safe in successive governments’ hands – and it is really important it stays so. But it will only do so, if politicians continue to appreciate the value of the NHS and its values.

Lord Victor Adebowale has written this article in a personal capacity

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