Andrew McKie: Doctors and nurses aren't saints and the NHS isn't sacrosanct

And it seems unlikely that the average conditions today’s employees, in any profession, compare unfavourably with those of, for example, 19th-Century millworkers or tin-miners. Anecdotally, however, many people do seem to think that their workplaces have become more stressful and unpleasant over the last few decades.

I’m not sure how to account for this. Is it that the current working-age population, coddled by 70 years of ever-increasing statist regulation and intervention, have an excessive sense of entitlement – the “snowflake” tendency? Or is it that old-fashioned paternalist notions in companies, particularly family-owned firms, have been supplanted by managers who, having no useful jobs to do themselves, justify their existence by throwing their weight around, and are under the impression that stress and pressures created for their own sakes are somehow an indication of productivity?

Probably a bit of both, I suppose. All the same, any firm which found that 38% of its employees reported that bullying was a problem in their own department would probably want to have a good hard look at how it was run. Which is why it’s worth paying some attention to the Christmas message from the chairman of BMA Scotland, Dr Lewis Morrison, that claims that the levels of bullying and harassment within Scotland’s NHS are “nothing less than a scandal”.

Naturally, as with all messages from spokesmen for the medical profession, this opinion is presented as, first and foremost, a “risk to patients”. It’s exactly like the way that any threat to the pay and conditions of rail workers is always presented as a risk to passengers. The BMA is nothing but the doctors’ trade union; it’s quite proper, indeed its entire function, that it should seek to defend the interests of its members, but it needn’t pretend that it’s doing anything other than that.

This, however, is symptomatic of the ailments which seem to infect any diagnosis of the NHS in general, if I can fling as many mixed medical metaphors into the one sentence as possible. It is an absolute requirement of British public discourse that the NHS is staffed by selfless saints, that the healthcare is provides is the envy of the world, that it is criminally underfunded, and that all governments, particularly Tory ones (in which category you may, if you wish, include all Labour governments slightly to the right of Lenin) are secretly trying to privatise it and sell it off to ruthless capitalists, so that everyone without a gold American Express card will be left to die in the gutter, as happens in every other country except ours.

Total rubbish, of course. And dangerous rubbish, because it prevents us from any clear assessment of what does make the NHS valuable and worthwhile, and of those areas where it is poorer than other methods of providing healthcare, such as those in operation in almost every other developed country.

Ignore America, always produced as the counter-example, because it has a uniquely inefficient, costly and unjust medical system. Just think, instead, of almost any other comparable economy – France, Germany, Canada, the Netherlands, Norway, Japan, take your pick – and wonder how the people there manage without an NHS, yet somehow seem not to have their streets littered with the bodies of the poor.

It can be simultaneously true – it is simultaneously true – that many NHS workers “go the extra mile”, as Dr Morrison puts it, and that the service provides good health provision under considerable financial constraints but that it is also bureaucratic, wasteful and no more than middling in its outcomes compared with the health services of other countries which spend about the same amount, and provide similarly comprehensive cover.

It’s also puzzling that, while every government since 1948 has been secretly attempting to sell the NHS, and every year we are told that we have only months to prevent this destruction of the jewel of our civilisation, the NHS appears resolutely unsold, and indeed to be consuming yet more of the taxpayers’ money. If there is some secret Tory plan to privatise the NHS, it must be the least efficient plot in the history of conspiracy.

Since the SNP came to power, NHS spending in Scotland has gone from £9.1 billion to a projected £13.1 billion for 2018-19, something which is claimed to be an increase of £4 billion. After inflation, that’s actually £2 billion, the money hasn’t yet arrived, and Audit Scotland says that funding is “wholly inadequate”, a real-terms fall of 0.2%, and that the service is in a “critical condition”.

All this demonstrates is that no matter how much money is provided from the public purse for the NHS, it will remain (as Dr Morrison puts it) “stretched to the limit”. With an ageing population, and the very fact that medical advances mean that more solutions to health problems, and thus more costs, are constantly being produced, that’s probably inevitable. That doesn’t excuse bullying, but it may explain the pressure.

NHS Scotland doesn’t seem to differ much from the rest of the UK in outcomes, despite the SNP’s outbidding of the other parties’ spending. Indeed, on many measures, it’s doing worse. Most of the country’s NHS boards failed to meet their eight key performance targets, for example, while their combined deficits and deferred repair bills are almost £1 billion.

But then, according to research conducted by the University of Plymouth, that’s less than half the amount that bullying costs NHS England – in what is claimed to be an “extremely cautious” estimate. As with the overall costs and results, there’s no reason to think that the NHS here is particularly different.

The supposed differences – that don’t exist – between the NHS under a Scottish government and the same system south of the border demonstrates nothing except the fact that banging on sanctimoniously about it, or even spending slightly more, doesn’t make a huge amount of difference to outcomes for patients, or to satisfaction amongst staff. The NHS will always be stretched to the limit, until we rid ourselves of the idea that what matters is the structure of the organisation.