Why should we save the NHS?

I have written before about striking doctors, and exactly what I think of the action they have taken. Though strikes were delayed and now taking place over January and February, my point remains. Hence I am not going to write another fully-referenced article, spelling out again what you can read for yourself if you want.
Instead, I want to ask a question. I want to ask this: why should we save the NHS?
Over the last couple of days, I’ve read plenty of articles and heard plenty of commentary in support of the strikes. What disturbs me is how much of the commentary heaps praise on the junior doctors for taking a stand, defending and trying to save our NHS. If tube drivers went on strike and, once out on the picket lines, switched their discourse from one of complaint about pay and conditions, to an ill-disguised admission that this is all about the politics of delivering transport services, they would be widely condemned. Yet no-one is really asking why one group of people, with one vision for future healthcare delivery, can abandon the sick and vulnerable in support of that vision. Is it, perhaps, the ugliest manifestation of what a monopoly can do? Perhaps, but I don’t think so, because if there was genuinely a private sector capable of competing with the NHS, it would not make such displays of piety and devotion to the cause any less popular with the public, or less frequent in nature. No, the problem is one of mentality: something we’ve all got to get to grips with.
I am neither pro nor anti NHS, however my position has been caricatured at times. As a patient, an employee and a relative and friend of patients, I find it hard to speak of the NHS as a single entity. When people speak of saving it, I’m left wondering, which bits? I have witnessed and experienced excellent, world-class care, delivered by fantastic men and women, passionate about what they do and noble indeed in their motivations. I have also witnessed appalling care: dismissive attitudes, filthy wards, poor communication and lack of co-ordination. The brilliant and the shockingly awful both form the complex picture of Britain’s NHS – an NHS where, despite the fact that no-one wants it to be the case, mortality remains significantly and unacceptably higher at weekends. Preserving the status quo, which the BMA and its striking junior doctors are trying to achieve (whatever professed willingness to negotiate afresh), means preserving (or ‘saving’ as the zealots would have it) both the good and the very, very bad. Who really wants that?

I believe that the most serious problem facing the NHS at the moment is a serious lack of scrutiny. That’s not because I have a fixed desire for or clear vision of an alternative: I don’t. A healthcare system that is good, needs to strike a balance between quality and access. Amazing services that no-one can access are as useless as appalling ones that we can all count on. Since ranking methods each give more or less weight to one of these3, attempting to determine which is the best healthcare system is unhelpful, and that’s before we even talk about differing demographic contexts between nations. The NHS does well enough on both fronts to survive, though since it is permanently in the grip of a funding crisis it is hard to see how we can sustain it. But by talking about the technical arguments in favour of the NHS, I am already engaging in a debate that the public and the political classes refuse to have: raising the question of why we should protect the NHS. There are plenty of nonsensical reasons cited in order to pay lip service to that debate: the NHS is free (it isn’t), it’s the envy of the world (again, it isn’t), it’s about morality and fairness (it isn’t). But if you really want to see whether a society is having a mature debate about its healthcare system, you need to ask yourself how often you think you’ll hear people say something along the lines of statement A or B.
Statement A: “We’ve got to save our healthcare system."
Statement B: “We’ve got to save these merits of our system. IF they’re under threat, we need to think about how we reform or what other system could do better.”
I believe Britain has an unhealthy attachment to the NHS, grounded in sentimental musings rather than a solid case. That’s why doctors can enjoy public support for abandoning the sick and vulnerable by striking in order to ‘save it’ or ‘stand up for it.’ We are all complicit in making the model king. The goal of keeping people well and giving them the best care possible when sick, should be foremost in our thoughts. That should encourage a healthy debate about the NHS, which must not only address reforms, the possibility of scaling it back, but must also include alternatives to a struggling, ailing system funded out of general taxation. Sorry, but other healthcare systems do a good job too. I would hope that if they ceased to do so, or their sustainability was seriously in doubt, those countries would do something different. But in Britain, when the government simply tinkers around the edges of the model, thousands of our doctors fight to keep things exactly as they are and there is a public outcry against the government. In Britain, the NHS has acquired for itself a monopoly over public imagination. In Britain, the model of delivery has asserted primacy over the principles of good healthcare, and that primacy is enforced by an unhealthy collusion between political leaders and the public to trot out all necessary myths to perpetuate that status quo. We express in glowing terms, our admiration and gratitude to the NHS. We talk of how it saves our lives and is there for us in our darkest hour. In actual fact, it’s people that do all those things – people that will still be there if you reform it, or replace it with a better system for providing universal healthcare. Challenging the NHS orthodoxy should not be seen as shorthand for attacking the principle of fair access to excellent services, or criticising/devaluing the hard-working men and women behind the services we in Britain are lucky to enjoy.
For my part, would I abolish the NHS? The honest answer is that I don’t know. I see a vast amount of goodness in it and I am not devoid of any emotional attachment to it myself, having worked in it and been cared for by it. What I do know, though, is that I want to hear the case either way, and I want the arguments for alternative systems aired. I want to hear what can be done to make your odds the same whatever time or day of the week. But all that gets drowned out by the constant cry of ‘Save our NHS!’
If I don’t want to be a social pariah or a political outcast crying in the wilderness, I’m not allowed to ask why I should agree. I’ve got to accept it as a self-evident truth. I can’t do that, because I’m not willing to defend the NHS just because it is the NHS. I’m willing to fight tooth and nail for it if it’s the best way to meet our health needs. If we don’t all learn to re-frame the debate, our NHS itself faces a bleak and floundering future as the biggest victim of its own iconic status. Then we’ll all be sorry.