Why are the Brits schizophrenic?

The British public remains proud of its National Health Service – although electors have shown little apparent concern at the non-stop organisational upheavals to which it has been subject over the past 30 or so years. The latest survey showed that 89% of adults in Great Britain support a national health system that is tax-funded, free at the point of use and provides comprehensive care for all citizens.

Oddly, however, 43% of those polled didn’t seem to care whether the service was provided by the NHS or another provider (e.g. private company or not-for-profit body such as a charity or social enterprise). 39% expressed an active preference for this care to be delivered by the NHS.

Although I’ve been out of the country for 25 years I understand this apparent schizophrenia.

I was heavily influenced by the anti-institutionalism of the post ‘68 period – seeing with my own eyes the complacency and protectionism of local bureaucracies. I avidly devoured the critiques of The Local State and the works of Ivan Illich (of Deschooling Society and Medical Nemesis fame)

I belonged to that small wing of the Labour Party which regretted that the party had, in the 1940s, turned its back on its “voluntarist” tradition and opted for the centralisation model (Egalitarian thought and labour politics – retreating visions; Nicolas Ellison (1994) nicely sets out the three strands (or “visions”) of Labour thought) 

Presented, however, with a choice between professional or managerial power, I opted for the latter - consoling myself that the “new managers” being promoted in the 1970s in the wave of enthusiasm for corporate management would challenge the complacency I saw. 

I never imagined that the managers would take over – and pave the way for the privatisation and commodification of everything!

At a personal level, I have always been wary of the “health system” – seeing its overworked doctors as too much as the prey of the pharmaceutical industry; and the fashion for monstrous new “factory” hospitals as horrific expressions of gigantism. Hence my activity in the World Health Organisation’s Healthy Cities Network – with its emphasis on health promotion and prevention.

And, from a distance, I have followed with distaste the various scandals which have erupted whether about medical malpractice or hospital mismanagement….

And yet I have never supported the neo-liberal project of privatising health care.

My partner challenged me yesterday on this apparent contradiction – how could I still support “the British model” given the views I have expressed over the years (let alone my own rejection of the idea of ever being hospitalised)?

I knew that the French health system represented one of the world’s best – and the US one of the worst but had been getting conflicting signals recently from the various international league tables with which we are now assailed. One table (in 2007) told me that the NHS was only 17^th globally for healthcare systems. Another (just a few months ago) focused on health and wellbeing (ie outcomes) and put Britain in 27^th place. But a survey conducted by The Commonwealth Fund last year ranked the UK first overall, scoring it highly for its quality of care, efficiency and low cost at the point of service, with Switzerland coming an overall second.

What are mere mortals to make of such contradictory reports? Fortunately there is help to hand – for example from something called “The Health Foundation” which published earlier in the year this short pamphlet which shines light on both the strengths and weaknesses of the British system. Knowing the scale of money from dubious sources behind Think Tanks, I checked out their website which gives reassuring answers to the obvious questions. Of course there are other, even better-known places where such analysis is conducted (such as the King’s Fund)…..  

But perhaps the most interesting find was this survey commissioned by the Health Care Commission

Views of the NHS and Healthcare have to be viewed at three levels.
Views of the NHS as a whole are often very different from, and influenced by different issues, than public perceptions of local health services, and different again from patient perceptions.

- The NHS as a whole, and in particular the principles it embodies, remains a huge source of latent pride. It is still perceived by the British general public to be one of the best of its kind in the world. People also see the NHS as critical to society, and despite concerns about its management, they feel it needs to be protected and maintained rather than re-invented.

- Despite this, the NHS regularly features as one of the biggest issues facing Britain today for the public. In early 2006, levels of optimism about the future prospects of the NHS reached their lowest recorded levels since 2002.

- However, public satisfaction with the NHS at a national level, and patient satisfaction, have remained relatively stable since 2000 and have recently shown signs of improvement. Patient ratings of their treatment are always far higher than ratings of the NHS as a whole.
 Our analysis highlights the impact of media coverage and politics on the NHS at a national level, where people rely on media coverage to form judgement.

Not surprising that the barrage of hostile comment about health care from those in the pay of corporate power (waiting to pick up rich pickings) has been having an affect.

I remain an unrepentant “mutualist” – believing that healthcare is too important to be left to commercial, managerial, political or medical interests on their own. It needs to be locally owned – with citizen interests balancing the others…..

I appreciate that this is a minority position which may indeed be seen as positively "cavalier" (Don Quixote) these days - so will try in future posts to explore what might be involved.....