WHAT a time to be Boris Johnson. The Prime Minister has emerged from hospital, after what is now understood to be a life-threatening couple of days in intensive care, as he battled the very virus against which he is leading the fight on behalf of the other 60 million of us.

He looked good; healthy, even. And he made a pitch-perfect, tone-perfect speech which was sent to the world via twitter and which has rightly received plaudits, reluctant or otherwise, from across the political spectrum.

Mr Johnson’s handling of the coronavirus pandemic has him enjoying record approval ratings. A poll on Sunday, by Opinium, had the Tories on 55%, the highest for 40 years, with the Government’s approval rating sitting at 61%. These numbers are likely to rise if the Covid-19 death rate plateaus and then falls, and one can be sure that Mr Johnson’s personal approval ratings (which were not polled by Opinium) will sky-rocket the next time a pollster asks the question.

Mr Johnson is deserving of these ratings. His job is the most difficult one a peacetime Prime Minister will ever do. He is in charge of a crisis which requires leadership, decisiveness, intelligence and compassion all rolled into one. He has proven himself to have all of these, as has our First Minister in Scotland, Nicola Sturgeon. Only time will tell if his strategy – in particular the move away from mitigation and towards suppression, which involved junking the economy to save more lives – will turn out to be the right one, but I cannot criticise him for any of the decisions he has taken so far.

Indeed, we are lucky that at the time we most need them, we have leaders who possess these characteristics. Can you imagine if Jeremy Corbyn had entered Downing Street after last December’s election? We could have been in the midst of a once-in-a-century calamity led by a person with precisely none of the qualities required to guide us through it.

However there is an uncomfortable, unfashionable, unpalatable truth about his five-minute speech. Because as rich as it was on style, it was poor on substance. Indeed, its key sections were patently unverifiable clap-trap. It represented the worst of British exceptionalism on the issue over which the British are always most guilty of it: the NHS.

I should say, as I always feel compelled to ahead of any critique of the NHS, that I am a supporter of universal state-funded healthcare. As someone without any private health cover, I am also a user of state-funded healthcare, and indeed for reasons those close to me will know, my family has been reliant on NHS provision over the last year.

Furthermore, I have huge respect for those who work in the NHS (again, those who know me will understand there is a very obvious reason for that). Our doctors, nurses and scientists are extremely well trained, by university medical schools and medical Royal Colleges which are renowned across the globe.

But the NHS is a system. It is a delivery mechanism for state-funded healthcare. It seems, to me, normal and relevant to compare it to the delivery mechanisms used in other countries, particularly those geographically closest to us in Europe, which generally have radically different systems.

Comparison yields facts. For example, the latest OECD statistics, from February this year, show that the UK spends over 25 per cent more public money per head of population on our health service than the average; a higher proportion than Norway, Denmark, France and Belgium, to name only a few. Only seven countries spend more.

Yet, despite this, the NHS performs poorly. It has 20 per cent fewer doctors per head than the average, and fewer than all the aforementioned countries. We rank 32nd for the number of hospital beds, with barely half the average. We have less than half the average number of MRI scanners per head, for CT scanners, around one-third.

And our outcomes, factually, represent poor value for money. For major cancers – colorectal, breast and cervical – our five year survival rates are 20th, 19th and 20th respectively. Our mortality rates from heart attack, haemorrhagic stroke and ischemic stroke are 22nd, 27th and 25th.

We have a top-ten input, and a top-thirty output.

This matters a great deal. Because when Mr Johnson says that the NHS saved his life, his words carry with them a British exceptionalism which is factually unmerited. And when he calls the NHS our greatest national asset, he is lacing his comments with a British exceptionalism which not only bears no relationship to reality, but which has long been responsible for a financial and human toll.

I know that this is an unfashionable time to question the NHS. Every Thursday at 8pm, we step outside our doors and we clap for the NHS. It is the most British of displays, appreciated I am sure by those who work for the service, including those close to me.

But, I fear, it bears risk. The risk that our behaviour, our pride, our exceptionalism, is going to make the NHS utterly impossible to reform at a time where we need to reform it the most.

When we exit the coronavirus crisis, we will do so at a time of economic destruction. To recover, we need to make every public pound work much harder, and we need to make sure our public institutions are lean.

Lean is not a word which could, with any real credibility, be attached to the NHS. That is not to say it does not do things well; if course it does. Our emergency service is very good. Our paediatric service, albeit heavily subsidised by charity and private funding, is good. Our ability to mobilise in a crisis like coronavirus is good, because of the ability to issue central direction. And our NHS staff are clearly of high quality, despite the relatively poor remuneration on offer.

All of that said we are, as a country, in terrible need of a mature conversation about how we deliver state-funded healthcare, which in truth has barely changed in 70 years.

We need to separate our love and admiration for our healthcare workers from the system in which they work.

And we need to leave our British exceptionalism behind and look beyond our island for examples of systems which work better whilst still delivering universal state-funded care.

We debase ourselves by dogmatically refusing to do so.

Andy Maciver is Director of Message Matters

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