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If the NHS ain’t broke, don’t fix it



I’m not one for banning things – least of all words.

But if I could put my libertarian principles aside for one moment and strike a word from the OED, then it would be ‘unsustainable’. Because never again do I want to hear the hackneyed phrase, ‘The NHS is unsustainable.’

I’m bored by it, I don’t believe it and I don’t trust it. We hear about how unsustainable the NHS is every other week – remarks from a Chief of the NHS here, quotes from an acute care director there.
It’s not even a new concept: this report from 1999 questions ‘the sustainability of the NHS in its present form’. And yet the organisation has staggered on for another 15 years.

Interestingly, the current narrative would have us believe that we must accept the demise of the NHS because the UK is broke and can’t afford it any longer, while the 1999 report blames – among other things – ‘public expectations’, which are ‘rising partly because of increased wealth’. So we’re damned if we’re rich, and we’re damned if we’re poor.

There is a strong political agenda behind the use of the word ‘unsustainable’, of course. If something is unsustainable then something must be done about it. And there’s no need to worry about whether it really is unsustainable – in our modern, fast-paced, read-the-headlines-no-time-to-think-about-what-it-actually-means-world if you just say something often enough then people start to believe it. And once we start to believe it.

However, all is not lost. This detailed report, with recent data from 2013, is not an ideological statements, but a summary of hard data on things that matter – like patient safety, effective care and access to care. Comparing 11 of the most developed healthcare systems in the world, the NHS came first, and not just first overall – the UK was ranked first in nine out of the 12 categories, and in the top three in all bar one.

Think the NHS is unsustainable because it’s staffed by doctors and nurses who are always making cock-ups in patient care? Actually we ranked first with the lowest rating for medical mistakes.
Claim the NHS is broken because no-one ever has a regular doctor co-ordinating their care anymore? We came top in that too.

Think the NHS needs an overhaul because British doctors are hopeless at explaining things? We topped the charts there as well.

And there’s more: want to complain that you can never see a doctor the same day when you need to? Try living in one of the other 10 countries that ranked below us.

Find it difficult to see a doctor out of hours without going to A&E? It’s worse everywhere else. Had to visit A&E for a condition that could have been treated by a GP? You’re less likely to have to do that in the UK than any of the other countries.

Most of all, whenever we hear the lie that the NHS is unsustainable because we can’t afford it, we need to ask just how all the other countries afford their (inferior) health service, given that ours is the second cheapest of the lot.

The report is such an endorsement of the UK system that you would think the UK press would want to celebrate it, but oh, the silence when there is something good to say about the NHS! The Guardian and The Independent did pick the story up but not a squeak emerged from the rightwing press, and the BBC drew a blank too.

Like any big organisation, the NHS is not perfect, and we should always be ready to learn from mistakes, but it is absolutely sustainable if we want it to be. It is the best healthcare system in the world, and we are very lucky to have it.

Dr Martin Brunet is a GP in Guildford and programme director of the Guildford GPVTS. You can tweet him @DocMartin68.