The NHS: Universal Public Healthcare – An Outdated Concept

Victoria Monro February 7, 2013 13


Yesterday, QC Robert Francis published his report into the failings of care at Mid Staffordshire NHS Foundation Trust, making 290 recommendations for improvement. David Cameron apologised for the negligence: he labelled the Trust’s performance as “truly dreadful”. What is to be noted, however, is that he admitted that the evidence seems to suggest that the failings of care are not necessarily limited to just this one hospital. Failings of care are perhaps occurring across the country – the issues that the QC has identified are not unique to this particular Trust. Just as this piece is being written, the Telegraph have reported a further 3,000 unnecessary deaths now being looked into. The concern that these terrible medical practices, fatal to so many patients, could exist across the board and in other hospitals doesn’t bear thinking about: 1200 is already a number too large, and it may well get bigger in time.

Cameron’s acknowledgement of more wide-scale malpractice is an interesting development from the general rhetoric of the Government, usually keen to praise the NHS in every comment it makes of it, including the criticisms. Nobody doubts that the NHS contains a host of nurses, doctors, surgeons and specialists who truly care about their patients, are competent, with a good work ethic, and the respect required for fellow human beings to treat them with dignity when they may be feeling their most humiliated. When a grown person has to ask a nurse to assist them with using the bathroom, it’s the medical staff’s job to do their best to make that patient more comfortable with what is happening to them. Many do. Many others don’t. Whilst good doctors and nurses enter the NHS system, a number of young adults with degrees but not necessarily the skills to put these to use in these hospitals also enter the public sector. Medical staff come in three strains: the first type, are those that are just utterly abysmal at their job, they may, or may not, have sufficient medical knowledge, but they don’t understand what it’s like to be a patient and they don’t know how to be good caregivers. The second are those who would be very good, but feel that the system they work in is so flawed and so incapable of producing good care (i.e. because there aren’t enough nurses for the number of patients) and therefore don’t aspire to do well because they truly believe that there is no point. Then thirdly, are those nurses that are wonderful, that try so hard to bridge the gaps left by the preceeding two types, that work all hours and develop a rapport and consideration for patients that truly enhances the patient experience. These nurses may work themselves to the bone to make up for all the other deficiencies – but it cannot reverse the underlying trend and attitude adopted by so many. Once these people are employed there, it’s very hard to remove them. Consequently, the system is flooded with medical staff that don’t treat their colleagues or their patients in a way conducive to good practices. The good staff are let down; the patients suffer most. It’s no wonder then, that a Trust can rack up 1200 unnecessary deaths simply from medical negligence. It’s almost a wonder it wasn’t more.

The Government wants you to think these incidents are one-off events. They want you to think that most of the time the NHS does well and that these ‘blunders’ are not significant, not meaningful, not representative of the system as a whole. But they’re also keen to brush the many significant failings the NHS is guilty of under the carpet. Negligence claims tell a sad story.

In the 2011-2012 financial year, the amount that the NHS owed in clinical negligence compensation claims was a total of £1.2 billion. A further £52 million was due in non-medical claims. South London Healthcare NHS Trust had a bill of £16.6 million in negligence payouts, and went into administration because of the huge debts it had managed to accrue. Barking, Havering and Redbridge University Hospitals NHS Trust paid out to the tune of £14.9 million, with Kings College London not far behind on £13.8 million.

The NHS is struggling: money is tight, and only set to get tighter. The population is living longer, and treatment for some illnesses is becoming more expensive than the NHS can truly afford. The best will in the world would find it difficult to reconcile this with good care. However, as long as we act as though these “failings of care” are single-events with few learning curves for the sector as a whole, we do a huge injustice to present and future patients.

One of the main problems with the NHS is the disassociation between action and consequence. By fully funding all medical health treatments without concern for how they came about, we do not encourage people to live healthier lives; essentially we offer people free rein over how to live their lives whilst promising them that the taxpayer will foot the bill for whatever they decide to do. This isn’t healthy for the NHS, or for future generations who will be saddled with the debt of paying for what the present NHS can’t afford, without any guarantee of a standard of care for themselves. The concept of a universal NHS is out-dated, belonging to a time when we lived well, died young, and had an attitude of self-reliance. None of these factors still hold. It’s time to face up to reality: a universal, fully public NHS can’t work. We need market forces, we need market-generated efficiencies (like, for example, saving £1.6 million in how paper is ordered) and we need to start giving people a vested interest in how the NHS functions, by connecting them directly with the medical provision and getting the government out of it. Paternalism and social provision helps nobody – when you take the time to look up the statistics, and don’t accept the Government’s hard and fast line on how wonderful the NHS is, it couldn’t be clearer that we may as well be flogging a dead horse.


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  • Ben Poser

    I could send you plenty of other statistics that point in the other way to you, and also plenty of strong arguments for paternalism (not that it’s necessarily my thing).

    I really object to the whole we have to pay for the mistakes of everyone else. Why should the fact they have made mistakes stop us treating them like people. They are still people. We can have this conversation in the common room sometime though.

    I’ve also got some good videos on how market incentives really fucked everything up in education, healthcare and other public services.
    I can also send you some interesting arguments that introducing markets to areas seriously corrupts original societal norms.
    I personally much prefer the idea of people going into healthcare to help people than to make money.
    Put the focus on money in healthcare and things are not going to go well for you.

    I definitely do understand the ageing population concerns etc.
    These are reasons to better fund the NHS though not just give up.
    So many lives at stake.
    It’s a pretty grim image having no NHS, at the very least I would like to hear more about a proposed alternative.
    Lets not throw something away that has done so much good so hastily.

  • Pingback: The NHS: Universal Public Healthcare – An Outdated Concept | Victoria Monro()

  • I’d be more inclined to believe this if there was evidence to back up your claims. Why are there 3 types of people joining the NHS? The compensation numbers stated are high but how do they compare against other systems? Do other countries have the same obligation to care for everyone like the NHS?

  • TheRedMage

    Presumably under Monro’s ideal situation, people like myself who have lifetime incurable chronic conditions (and thus uninsurable by private insurance) would be practically euthanised by laissez-faire. Nice.

    • Ben Poser

      Only seems fair though mate doesn’t it.
      It makes for a “grim image” but chin up ‘ey.

  • Excellent post, it would be a leap forward if debate on the NHS moved on from the “it’s the NHS or America” banal dichotomy.

    Most developed countries have some sort of mixed private/public, insurance or personal contributory model. Outcomes are as good or better than the NHS, and there isn’t an issue of lack of access.

    The NHS model is broken, neo-Soviet and fundamentally incapable of delivering the incentives needed to stop the malpractice that we have now seen exists in many parts of the sector.

    Moreover, moving to an insurance based model will start delivering incentives upon people to consider the health care costs of their lifestyle decisions, rather than calls to tax and regulate the lot of us, for the poor choices of a minority.

  • Dougie

    “free rein”

    • Both rein and reign in this context are acceptable (modern “free reign” is now accepted), but as someone who is concerned with linguistic purity, I concede on this, and have changed it 🙂

  • J A Jones

    Nothing will improve until individual patients have to make a personal financial contribution to their treatment. Something for nothing is not valued by most people.

  • Kerry Manning

    Sadly, Victoria, I think you have hit a rather unfortunate nail on the head here. It is a grim truth that the NHS probably won’t last much longer, it is just deeply worrying that many in the UK won’t be able to cope without it. For many years I considered myself against privatised healthcare, but utilitarian dreams are all well and good until, like you say, it comes to footing the bill, and ultimately the strain it creates on the services naturally lowers the standard the NHS is able to provide. But I do worry about what will happen to the poorest in our society with the removal of free healthcare, with cuts to many local services already affecting plenty of people in the less affluent areas of the country. Grim times ahead.

    Great article by the way, incredible well researched and written.

    • Thank you for your comment. 🙂 I completely agree that it makes for a grim image if the poor and vulnerable can’t access good healthcare as a consequence of removing the public, universal NHS system as it presently is – however I would say that a system by which the poor/vulnerable could access good healthcare would still be possible. In contrast, making this system work for everyone (or indeed, anyone) is impossible.

      • TheRedMage

        I guess there would be no “poor/vulnerable” people with chronic health conditions and disabilities in your anarcho-capitalist utopia because they would have all died out due to lack of medical care. I am happy to saw that I do not share your extremist law-of-the-jungle beliefs.

  • JamesW

    “encourage people to liver healthier lives”

    Freudian slip? Hic!