If the NHS wasn’t here, it would need to be invented. I have lived in the UK for over 40 years, coming as a student and staying. I have the benefit of a local passport as my parents lived here when I was born. My family and I have benefitted from the NHS over the years – nothing catastrophic, just the minor stuff of illness and pain. But if we were to suffer catastrophe, I have the peace of mind to know that the NHS would be there – not just for me, but for all citizens who have equal access to its services.
Contrast that with the care in the US. Americans are both fitter and sicker. The divide is stark. You might imagine all Americans have gleaming rows of white teeth – that is not so. My in-laws, a couple, between them have one set of teeth. They can’t afford health care, so both have large gaps that if they were able to combine their smiles the gaps would largely disappear. When the US mobilised the National Guard to invade Iraq, the state of Washington found that its troops could not go into sustained engagement without getting their teeth fixed – about 30 percent of the 4,500 guardsmen called to active duty in Washington were discovered to have dental problems so severe they were unfit to go overseas (Seattle Times, May 21, 2005).
The US has a number of medical charities that service the Third World. Remote Area Medical (RAM) visits Tennessee, Kentucky, Virginia. Yes, Third World when it comes to health care in the US. It is a country of extremes in all things, health care most starkly.
That is why the Affordable Care Act – christened ‘ObamaCare’ both by those who support it and those who deride the president – is such a significant piece of legislation. Though America spends north of 18% of GDP on health care, in contrast with 9% in the UK (up from the paltry 6% before the last administration’s investment), it still needs charities like RAM to provide basic care. ObamaCare will extend coverage to 50m more Americans, members of my family included. We have been lucky so far. My uncle had the ‘good fortune’ to become mentally ill when in the service of the US Navy, so was able to be cared for by the VA for over 50 years. My mother often talked about the ‘what if’. My nephew contracted cancer when my brother had conveniently landed a job in a bank. £250k over 10 months sadly did not extend his life, but the best care was available. Had my brother remained unemployed then who knows what – there was very a limited safety net that would have provided for him. As it was, his daughter was born with the support of charity care.
Americans like to think of themselves in terms of resilience, independence, and the ‘can do’ spirit. My cousin (other side of the family) rallied against the Affordable Care Act because it would support ‘scroungers’. I spent a week in the company of Tea Party members and doctors as the bill was going through Congress, and the vitriol was so thick you could cut it with a knife. Though the Supreme Court again ruled in its favour, ObamaCare is still not secure, as the Republicans short term will keep searching for ways to repeal or amend the provisions. But like gay rights, I think time will let what reasonable people see as reasonable provision become embedded in society. It may go some ways towards reducing inequity in society, in the same way the NHS has.
While we admire the NHS and celebrate it at the Olympics – as Nigel Lawson observed, the NHS is “the closest thing the English have to a religion, with those who practice it regarding themselves as a priesthood” – it is in much need of change. The £30bn shortfall in funding against rising demand and expectations points towards radical change, not just tinkering at the edges – too much variation, too little standardisation, too much waste, too many barriers, too little integration, too many silos. The NHS remains largely an illness service and acute hospitals highly specified nursing homes. It wasn’t intended this way, but that’s the way it has become. The service is still largely designed around producers, and not enough responsibility is expected, or accepted, by consumers. Obesity, for example, is a Tsunami resulting in diabetes, lost productivity and loss of confidence, yet it is largely preventable.
So who will change this? Well, those who go through Academy programmes like Nye Bevan are the vanguard of a revolutionary core in the NHS. As a bureaucracy the NHS has been impervious to change, but this in itself has to change. A new type of leader needs to emerge – one who succeeds by making others successful, who through effective engagement earns the legitimacy to challenge ‘the way we do things around here’, who speaks and acts in more than traditional languages of command and control, who represents the diversity of the communities they serve and the staff they lead – and who sets the example for health, lifestyle and wellbeing that becomes a model for citizens to emulate. I look forward to working with these leaders and to jointly make a difference.