Will none of our great political parties do something real and meaningful (as opposed to eye catching and cosmetic) about the NHS? The horror of health poverty in the USA means that our NHS appears safe and virtuous, almost cuddly. At least in this country nobody goes untreated for want of adequate means. This appears to be the broad consensus of UK clinicians, pluckily pulling together for the good of the patient, and the public at large, fed a constant healthy diet of positive statistics.
But this comfortable place is actually the cradle of complacency; look how dreadful our cousins are, surely this proves our virtue? But we look too often in the wrong direction. Much closer to home, in fact all across Europe, we are shamed. The pinnacle of our achievement is a wait of eighteen weeks from referral to treatment. Yes, that is 18 weeks, or four and half months, or 126 days. Can you imagine a bilious French man waiting 126 days for relief, or an Italian with angina relaxing while four and half months pass. A trip to the local Urgences is as much part of our family holidays as the vineyard tour, and the speed, efﬁciency, quality and sheer brio of these continental units always impresses. The greatest virtue of the NHS is the principle that health care should be available to all regardless of the ability to pay, it’s greatest vice is the belief that only a politically driven, monolithic organisation can deliver this. It didn’t work in Moscow; it won’t work in Maidenhead.
Diversity of supply is absolutely critical to maintain the quality of any state organisation. Would the BBC be the great (state funded) national institution that it is without ITV and Sky to ensure that it never gets complacent? While for the BBC there may not be commercial funding pressures, there is certainly competition for quality, diversity and accessibility. The artiﬁcial so-called market within the NHS, where national money (after all it comes from the same pot) is pumped backwards and forwards by an army of bureaucrats, is criminally wasteful: while ﬁning NHS hospitals for failing to meet targets (ﬁnes paid by the NHS, to the NHS, using NHS funds) would do justice to Kafka.
So when the diktat goes out from Whitehall that nobody will wait more than 18 weeks for treatment, sure enough everybody waits around four months: an aspiration to failure. With an election in the ofﬁng the real question is will any party have the political courage to try and open the eyes of the public to what they are entitled to, but have not yet, received. Maybe it would just be easier to move to Westphalia?
Guy Lloyd is a cardiologist working at Eastbourne with a special interest in cardiac imaging. He is director of R and D and also involved with various local and national bodies especially the British Society of Echocardiography.