The NHS is in crisis. We know that. At least, anyone who has tried to access mental health services on the NHS will know it. Anyone with loved ones suffering from cancer who have been told they cannot have their treatment of choice will know it. In fact, anyone keeping vaguely abreast of the news should know it.
But despite being – by all accounts – on its very last legs, the health service is just about managing to cling on. So what happens when it does all fall apart, when Tory cuts bring it to its knees, ready for that final bullet to the head?
I rang up Mark Dayan, Policy and Public Affairs Analyst at Nuffield Trust – a charity that aims to improve healthcare in the UK – to talk about what to prep for ahead of this impending doom.
VICE: When you look at the media we've been talking about the NHS crisis for so long. How close do you think we are to any kind of brink, and why is it so hard to quantify that?
Mark Dayan: I don't think there is some kind of brink where one day it's fine and then the next day everything is absolutely terrible. There's been steady growing pressure on the NHS over the last few years. Some things still get better – technology is getting better – but access to care in particular has obviously been getting worse. If you look at times that the NHS has struggled in the past, that can just keep happening. Waiting lists will go up and get longer, people find it more difficult to see a GP. Unfortunately we will see these pressures continue to build up over some time.
When you say there were these points previously, how bad has it been before?
In the 1990s, for example, for standard operations like a hip replacement, a wait of a year-and-a-half was not that unusual.
It's not as bad as that now, right?
Nothing like that now. At the moment most patients are seen within about four months. That's just an example of how things can continue to get a good deal worse in terms of accessing treatment than they are now, and you still wouldn't have some kind of collapse – it would just be increasingly difficult to access care.
**In that particular instance how was it resolved? ** The NHS fixed that partly through getting an awful lot of extra money through the 2000s, which brought it close to the average for a European country in terms of how much money it had. Also, a lot of the incentives and targets pushed people into using that money to reduce waiting times, in particular.
Can you hypothesise what will happen as we head towards an imagined collapse?
I think there are a few things. Firstly, as I said, waiting times would continue to get worse. I'm talking here in maybe a decade's or so time. Most people, including Jeremy Hunt, have agreed that at some point the NHS will need more money, but if it didn't get any then waiting times would get worse, both at the GP level and for hospital treatment and in A&E. The NHS would not be able to keep up with cutting edge technology, which arguably is already the case for some cancer drugs, for example. Survival rates might start falling behind the wealthiest countries. Lastly, more people would probably give up on the NHS and take out private health insurance as individuals or through work, which again is something we saw in the 1990s when the NHS was under great pressure.
If more people were going private would that perpetuate problems?
Well, in a sense, it takes some demand off the NHS, so that's positive. But there is a possibility that it might undermine political support for the NHS if a significant portion of people don't rely on it.
Do you think there will be a collapse?
I believe there would never come a point where the NHS just didn't exist. But it wouldn't be able to offer cutting edge treatments, which is pretty bad. I also don't think it's likely that whole areas of disease would stop being covered by the NHS. If they did it would be more likely to be perhaps people who seem to have relatively less harmful health conditions. For example, it's much harder to get varicose vein treatment on the NHS than it was a few years ago, because in many cases that's sort of not a medically dangerous condition, even though a lot of people want to have it sorted. I would expect it to be things like that that would be potentially rationed more.
Why do you think it's so unlikely?
I think the disruption from abolishing the NHS and moving to a different system would be huge. But fundamentally, public opinion is very firmly in favour of the NHS and has been for a very long time. It's, in fact, one of the strongest British opinions, which makes me think the government wouldn't want to do that as it'd just be so unpopular. All the major parties basically support it.
So it would have to be a very right wing government – far more so than our current Tory government.
Exactly. At the moment, at least, getting rid of the NHS is not really in the mainstream of politics. UKIP, who are in some senses quite a fringe party still, have had internal struggles about whether or not they would suggest replacing the NHS. Even Margaret Thatcher's government, which rolled back market ties in large areas of public service, never touched the NHS because of the understanding that it held a special place in British public opinion. It's not impossible that at some point they might replace the NHS with another system, but that would be replacing it rather than just getting rid of it and not having healthcare systems.
What would happen if they scrapped it and had to put something else in place?
Some other countries have what is called the social insurance system, which is where money is taken by the government from your pay cheque to pay into an insurance fund that provides healthcare. You can argue about how different that is from the NHS, which is funded through taxes. France has this system, for example. Other countries have a privately provided system – for example, Singapore – where you pay into a private savings account or insurance scheme and that then pays for your healthcare. In America there are still some people who don't have health insurance, and if Obamacare was to be repealed there would be more. Wealthier people in America would also tend to have better health insurance, which means they pay less out of pocket. It is quite different to the NHS system, but at the same time the American government still has to pay for a lot of healthcare through schemes like Medicaid and Medicare.
Are experts starting to consider options for if the NHS continues to decline or collapse?
Most of the research and thinking is being done by think tanks in the civil service, and it's about maintaining and improving the NHS we've got at the moment and not about replacing it. There are always right wing think tanks, like The Institute for Economic Affairs, who basically want the NHS to be replaced by a more market-driven system, and they're still very up for that. They periodically come up with proposals for replacing the NHS wholesale. I think they would tell you themselves that they don't think that's likely to happen anytime soon.
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