So, What Is Wrong With The NHS?


Brexit aside, the NHS is probably the subject most likely to divide opinions in Britain these days. You can hear it referred to as “the best healthcare system in the world” and also as “outdated, inefficient and not fit for purpose”. You can hear stories about inadequate service, neglect, huge waiting lists, waste and chaos alongside stories of great care and professionalism. There is no doubt the NHS is a very integral part of the British existence, so much so that I think it also became part of the British identity. It has definitely got a special status. No politician in his/her right mind would touch it with a barge pole. Any policy makers daring to suggest that maybe the traditional way the NHS runs needs a change is seriously risking a fierce backlash that may put their future careers at risk. It all becomes very emotional. I, however, am not a politician or a policy maker so I am completely relaxed about saying what I think on the matter. I have also seen how Health Service can be delivered, in a different way to the NHS, in other countries.

Before I start it is important to make 2 points very clear!

Firstly, is the fact that I have no personal interest or bias regarding the matter. If anything, my own business is benefitting greatly from the failings of the NHS. My only interest is my despair at watching this great institution crumbling under its own enormous weight, unable to supply the high level Health Service the citizens of this great country deserve!

Secondly, none of the criticism in this post is directed towards the NHS staff. The great majority of the NHS staff, particularly the Doctors and Nurses, are very professional and hard-working people. The failings of the NHS are not their fault. If anything, they are another victim of the problems. Having to work in an under-staffed, under-financed and often chaotic organization can’t be fun. They deserve more just as the patients do.

 Those “Drs and Nurses” are often used by people who are resisting change in the NHS: “How dare you criticize our wonderful Doctors and Nurses who work so hard to save people’s lives.” Well, I don’t. Actually, I never heard anyone do so. This hysterical tone is very common everytime the issue comes up for discussion. Another common, and no less hysterical argument, is that any suggested change is somehow an attempt to privatise the NHS by the back door. An interesting thing happened last night. As if to help me demonstrate my point I got an email from Mr Stephen Fry urging me to sign a petition calling for the Government not to allow any American companies to apply for any contract relating to the NHS. I am a big fan of Stephen Fry (anyone who watches The Black Adder Goes Forth or listens to the Harry Potter audio knows the man’s a genius!). I know he had some problems with his health, I assume he has been treated by the NHS and now wants to do something to help. That is great but is it helpful? For a start, why single out the US? What difference does it make from which country is the company? It sounds to me very much like discrimination. Secondly, who is to say that UK companies will necessarily do a better job than a company from abroad? You may not be aware of it but in today’s Global way of doing things, foreign companies are running a few of our operations in the UK, just as UK companies do in other places around the world. So long as those companies comply with UK rules and regulations and supply a service at the level required by the UK Government then it doesn’t really matter where they originate from! In any case, my point is that this is nothing to do with privatizing the NHS. Indeed, many private companies are already taking part in running different parts of the NHS at this present time. I think the greatest fear that people have is that treatment may not be available (free) when they need it.

At the moment, anyone in the UK can be treated for free on the NHS regardless of their age or their medical condition. This principle should be preserved. People are looking at private insurance companies, like BUPA, PPP etc, and worry that the future of the NHS will look like them. The panic is understandable. These companies are a rip-off. They charge high fees that will be unaffordable for most people and, worse, these fees grow exponentially if your health deteriorates. It is understandable why people panic when they hear the words private and medicine used in the same sentence. The good news is there is a third way. Great Health service is possible without the need for poor and poorly people having to pay a lot of money for it. I will explain how this third way works later but first, what is actually wrong with the NHS at the moment?

Where do we start? Well, to simplify I’ll focus on two points: availability and organization.

The problem with availability, or the lack of it, is probably emanating from the lack of resources, there are simply not enough doctors, nurses and medical facilities for the size of the population it serves. As a result we often need to wait two to three weeks before being seen by our own family doctors, or many months before seeing a specialist. I have to let you in on something, citizens of this Great country: this situation would be completely unacceptable in any other country. I was about to write “in any other developed country” but thinking about it-no, any other country. More than that, it would sound ridiculous to them. If someone is suffering why do they need to wait for weeks or months to get help? Yet somehow it has become acceptable in this country.

As to organization, the NHS is massive, one of the biggest organisations in the world. I keep on hearing stories regarding the insufficiencies of its practices. Nothing demonstrates this point better than the failure to implement a computer programme for the NHS. Amazing as it sounds, NHS hospitals and other institutions don’t have an electronic way of communication between them eg patients, patients’ notes, tests and so on. More than that, even within many hospitals there is no one computer system to connect all the different wards and departments. This is causing an enormous waste of time and money, not to mention problems with a good level of medical service. For example, imagine a consultant facing a patient who has been in different wards in the hospital before. He needs to have all the information about him, there and then, on his computer screen. Because of this problem that is often impossible. The lack of a single unifying NHS computer system is just one example of inefficiency. Unfortunately, I have to say indifference towards inefficiency is a typical phenomenon in the public services.

People are probable expecting me to talk about the ongoing refusal of the NHS to use any complementary medicine. Whilst I am sure that incorporating therapies like Chiropractor, Acupuncture or Herbal medicine in the NHS will help a lot in both improving the service and saving money, I also think this problem is dwarfed by the problems of lack of availability and organization. Actually, it has just given me an idea for my next blog: should the NHS use Complementary Medicine? But now back to our issue: what is the problem with the NHS? I was talking about lack of availability which is mainly resulting from a chronic lack of adequate funding plus organisational problems and inefficiencies which contribute to the lack of funding problem as well as reducing the level of service.

So, what is the solution? Well, the tragedy is that the solution is very simple. There is no need to reinvent the wheel or come with some super- sophisticated plan. All you need is the political will to change and then just look across the Channel to Europe. Many countries in Europe have health services that are operated and funded in a different way to the NHS. The levels of service are enviable and it doesn’t cost much. My own experience is with the system operating in Israel. I know many countries in Europe have the same, or very similar, systems.

So, how it works? A number of private companies are the Health providers. A person can choose which one he goes with. This creates healthy competition between them regarding both the level of services and the prices. The prices are means-tested and also supervised and limited by the State. The monthly contribution only depends on your level of income (like a kind of Health income tax) and you will never be asked to pay more just because you use the service more (which is the case with private health insurance companies). So this Health Service is always available for everybody at anytime as long as they pay their fees. These fees, by the way, needn’t be high and are worth every penny. The Health Service you’ll get will be superb, a world apart from the current deficiencies of the NHS. An added bonus is much more money for social services, education and other public services. Some people may object to paying for Health Service. Well my answer is: we really don’t have much choice. The system of funding the Health Service from general taxation is clearly not fit for purpose and is having a disastrous effect on other services. Most people said in a survey they’ll be happy to pay if they know they’ll get a better service. It doesn’t have to be expensive: if everyone pays (it has to be compulsory) then the individual fee is quite small. And the bottom line is: we can see it is working beautifully in other countries so why not in the UK?

Best Health for all,

Dr Ilan Shahor