YOUNGER readers may find it hard to credit, but there was a time – oh, probably more than quarter of a century ago, now – when the defining point of the NHS was generally thought to be that it should save us, rather than that we should sacrifice every aspect of life, civil liberties, political discourse and the economy in order to save it.

There’s no doubt that the NHS is under tremendous pressure; the Army has been drafted in to help to run ambulances; there are significant staff shortages – short-term ones caused by Covid isolation and unprecedented pressure, and long-term ones caused by overall under-staffing – A&E waiting times are at an all-time record high; in-patient treatment declined by a fifth in the five years before the pandemic; and drug deaths are the highest in Europe.

The last of those is nearly four times higher than the figure in England, while delayed discharge figures are three times worse. But, although healthcare is entirely devolved, not all of this is the SNP’s fault, even if their response to these problems is often shambolic, capital funding has fallen by more than 60 per cent on their watch, there’s a £1 billion backlog in maintenance issues, and their decision to cut hospital beds by 1,200 over the decade up to 2019 now looks, in the jargon, “sub-optimal”.

The most recent King’s Fund report suggests that NHS England is doing a bit better, but only a very little bit. Everyone, including Westminster government ministers as well as their critics, is warning of the danger that the NHS will be overwhelmed this winter.

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Given that the already insufficient numbers of staff have been run ragged for two years, and that there’s a huge backlog of non-pandemic-related conditions, that seems perfectly possible, even if the rising numbers of Covid cases doesn’t – thanks to widespread vaccination – translate into unmanageable hospitalisations.

We can be sure it’s a real threat because the NHS across the UK operates at maximum capacity and is stretched to the limit every winter, even without an ongoing pandemic. The only way to deal with this is substantially to increase NHS funding.

Except that it isn’t. In the whole history of the NHS, there has only been one year (1954-55) in which it has not received a real-terms increase in funding of more than two per cent – and for more than half of the years of its existence, it’s been higher than four per cent.

Along come the latest figures from the Organisation for Economic Co-operation and Development (OECD); ie, the world’s rich countries (its 38 members are responsible for 62 per cent of global GDP). These show that the UK’s healthcare spending, as a proportion of GDP, is the world’s second highest.

The total is not just more than double that of notoriously third-world systems such as, say, Luxembourg, and more than double, in terms of GDP, what we were spending in 2000; in both overall totals and government spending it’s way ahead of places like Denmark, New Zealand, Canada and France. The closest EU comparison is Germany (where the system is paid for through a mixture of state and private insurance, and the government has virtually no role in delivering care or service, almost all of which is private). Only the US spends more than we do.

The nature of UK political discourse when it comes to the NHS demands that when anyone suggests that this means more money, and nothing but more money, is perhaps not the solution to the NHS’s problems, they are accused of wanting to emulate the US model, and privatise Our NHS.

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But no one – not just no one in UK politics, but no one anywhere in the world – wants to emulate the American model, not least because it tops this table for spending, and yet millions of its citizens have no effective health cover.

And no one, to judge by the evidence, wants to privatise the NHS, since the Tories (who are always accused of this ambition) have been in power for most of the period of its existence, and not only haven’t done it, but keep saying they don’t want to. The total cost to the NHS of private contracts (which includes almost all equipment, drugs, catering, linen and so on) has remained constant at about seven per cent since the NHS was founded, and according to the King’s Fund, actually fell slightly under the Conservatives before the pandemic.

There are those who like to maintain, simultaneously, that the NHS is “the envy of the world” and a basket-case on the brink of collapse because of underfunding. Unfortunately, the figures suggest it’s the other way round. It’s not the envy of the world, but at best a mediocre, and on many comparisons fairly poor, service, despite us spending more on it than any other nation on earth (bar the US).

Even the Commonwealth Fund, which usually gives the NHS good ratings on all sorts of things from access, administrative efficiency and “equity”, puts it way down the international rankings on “health outcomes”. Not all of us will share that overall judgment; some of us think keeping people alive is among the more important jobs, and that, for example, cancer recovery figures are a greater priority than diversity or management mission statements.

None of this is the fault of NHS doctors and nurses – despite our spending, we have fewer doctors than the OECD average (and nearly every European member state), and about the average number of nurses, though Switzerland and Norway, with their mixed-funding, non-NHS systems, have twice as many. We have about 2.4 beds per 1,000 people. That’s almost the lowest in Europe and compares with about six per 1,000 in France and eight per 1,000 in Germany.

If we have (as we do) dedicated, high-quality medical staff and our health service costs more than that of almost any other country on the planet, but we are getting worse health results, and at the same time putting both the infrastructure and the staff of the NHS under a strain that, every year – even without a pandemic – brings the system to the verge of collapse, we’re doing something wrong. Something that most other European countries, with similar universal access but better results, aren’t. And it isn’t failing to spend enough.

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