When the NHS was founded back in 1949 the world looked and felt a very different place. In the post war era diseases that could easily be treated all too often killed the poorest in society because they couldn’t afford the treatment needed. Pneumonia, Polio, TB, Meningitis and Diphtheria ripped through the underclasses murdering at will. Infant mortality was around five per cent and nothing had improved for twenty years.
Doctors shrugged their shoulders. It was not their problem that people died. The Hippocratic Oath only applied when treating those who paid. When Attlee and the Labour government of the time started to introduce the concept of the first free at the point of delivery health service the BMA fought tooth and nail to prevent it coming into being.
Almost seven decades later, the NHS has been a huge success. The five major killers have been consigned to the dustbin of history, infant mortality rates are negligible and average life expectancy has increased from 68 to 80 years old.
Yet for all the praise the NHS receives, the UK has been overtaken in life expectancy by numerous countries in Asia, Americas and Europe whilst even at the same time the money being thrown at the system just cannot keep pace with what is being demanded.
So why is it not succeeding in the same way it used to?
The NHS model, where once upon a time cured people, is now killing people. The reason is simple – the NHS was set up to treat disease, it was never intended to treat lifestyle choices.
Pneumonia, TB and the like weren’t chosen. If you lived in overcrowded slums and were dirt poor, chances are a disease like this would come and chose you. Yet today, the major killers amongst the poorest of society have been replaced with diseases related to smoking, drinking, obesity and leading a sedentary lifestyle – choices that an individual makes about how they live and die.
And herein lies the problem. Because the service is ‘free at the point of use’ it is now abused rather than used. No other system or service in the UK offers people unlimited access to something in the way the NHS does. It means that people can think that it doesn’t matter whether they get Type 2 diabetes or cancer or lung or heart or liver disease from their smoking, drinking, overeating and lack of exercise because the NHS will treat them for free and on their terms. Operations costing tens of thousands; ongoing medicinal treatments; bariatric bands, you name it, you can have it. For gratis. No questions asks. No demands to change your lifestyle or any carrots, or for that matter sticks, for those who choose to make themselves more likely to be sick. And there is no sword of Damocles to wield if they don’t pack in the fags, stop the boozing, give up the fried chicken or start walking for 30 mins each day then they don’t get treatment.
Sure, marketing and society tip a nod and a wink to people to say that excessive drinking and eating, and to a lesser extent, smoking, are all perfectly acceptable. But the lack of motivators to either stop or not take them up in the first place is preventing the NHS being a health service. Instead it is being a sickness service, picking up the pieces when they are broken, not stopping them being broken in the first place. It is encouraging people, especially in the poorer sections of society, to ignore the dreadful habits that are severely detrimental to their quality and longevity of life. It means, in the end, they live less and die younger and cost other taxpayers a spank load of extra money.
This is why the NHS is failing the very people it was originally set up to help. There are no tools in the NHS armoury to help encourage, penalise or persuade someone to pull their finger out and do things that stop them clogging up the wards and the surgeries, save money for the taxpayer and ensure they are able to see and play with their grandchildren in later years.
Does that mean looking at an insurance style of healthcare system to help? There are advantages. If you knew that if you were healthy you would save your self money has to be a carrot that is worth dangling to any family on the breadline.
Yet, as with all these things, there are pitfalls as this was the very system that left so many poor people in the mid 20th century with no care at all. But times have changed. The NHS ideal was wonderful, but it is dated, costly and failing to help those it once served so well. In fact it is killing them. Until the NHS is overhauled then this will get worse and costs will continue to soar.