National Hate Service

The Daily Mail just proved that the British press' rhetoric on the NHS hasn't changed in 40 years.

I absolutely realise that today’s image looks like a terrible newspaper cartoon. “Fear!”

Previously: The Blimp Deflates
Obituaries and tributes to Paul Johnson, a columnist with a penchant for 'entertaining' bigotry, show tedious contrarianism isn’t a modern affliction.

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On Sunday, the Mail gave recently-deceased Pinochet fan Paul Johnson the chance to pontificate from beyond the grave by reprinting a column he wrote about the NHS in 1991. Its intention was to prove “little has been done to make the NHS fit for modern times and the seemingly endless demands put upon it.” What it actually illustrated is the constancy of distorted rhetoric about the health service in the British press.

Thirty-two years ago, Johnson wrote:

The NHS is the sacred cow of British politics. Everyone has to say how marvellous it is. No one dare attack it, except by stealth. Many of those who work in it are dedicated and industrious. Others are under-employed.

In many ways, the NHS is an old-fashioned nationalised industry: inefficient, overmanned, over-unionised and a staggering financial burden. It employs well over a million people, only two-thirds of whom are directly involved, as doctors and nurses, in tending the sick.

The only other institution in Britain which has a longer payroll is local government, itself a byword for profligate use of manpower. The supposedly niggardly Tory Government raised spending on the NHS by a third in real terms.

Yesterday, Matthew Syed wrote in The Sunday Times:

The British state is breaking. Hours of delay at A&E, the Passport Office taking months to provide a service, the impossibility of getting a GP appointment — you name it. Strikes are one of the causes, but many, particularly on the left, regard them as the consequence of years of underfunding. Taxes may be at their highest for half a century, but we are told that we should pour more money into public services. I have to confess that I am not so sure.

Meanwhile, over in The Sunday Telegraph, Keir Starmer did his “suburban father angry that TGI Fridays has no record of his booking” act:

[I am not] prepared to accept the idea that the NHS should somehow be off-limits, treated as a shrine rather than a service. It is incumbent on those who want to fix it to be frank about what has gone wrong and how only a proper programme of reform and renewal will get us out of crisis… 

… We also need to be ruthless with the bureaucratic nonsense you encounter every day in the health service. Why can’t people with persistent back problems self-refer to physio? Why if you notice bleeding do you have to get a GP appointment, simply to get the tests that you then do yourself at home?

That ludicrous line about bleeding — this time described as “internal bleeding” — was reused by Starmer during his appearance on Sunday with Laura Kuenssberg, where it and the pretence that you cannot already self-refer to a physio were treated terribly seriously and subjected to almost no pushback.

Still, Starmer’s decision to debase himself in a Telegraph title again earned him no favours. Today, Tim Stanley writes:

All hail Labour’s revolutionary turn towards being pro-consumer, though its solution is Stalinist. It’s logical to say that a socialist system only works if it is entirely socialist, centrally controlled and planned – and our experiments in decentralisation have been flawed. For instance, the Government argues that it needs to institute minimum service level agreements in the event of an ambulance strike precisely because the NHS is a federal system. The unions do have emergency back-up plans but they are organised on a trust-by-trust basis, and “heart attacks”, to quote Grant Shapps, “do not accept or work to the boundaries of trust borders”. But if the answer to NHS failure is more NHS, won’t this just spread existing problems further?

The paper’s new section has a piece based on anonymous briefings from Department of Health sources headlined Labour’s plan to ‘nationalise’ GPs would cost more than £7bn alongside another that claims NHS ‘bed-blocking’ fuelled by 50 steps needed to discharge fit patients.

The newspaper consensus that the NHS is broken because the system is intrinsically unworkable is also hammered home today by The Times. Repeating the trick it pulled with its ‘Times Education Commission’ in 2021/22, the paper has announced the ‘Times Health Commission’. It’s a neat trick that allows The Times to appear ‘neutral’ while selecting ‘commissioners’ that it knows will come to the conclusions it wants and ending up with a report that Tories and Labour alike will “welcome”.

The terrific wheeze was introduced via a Times front page today, headlined Two in three voters think NHS offers bad service in print and online as Public faith in the NHS collapses. A YouGov survey commissioned by The Times for the launch of “the ground-breaking year-long inquiry” — like beauty, whether something is “ground-breaking” should really be in the eye of the beholder rather than the boastful — says 80% of people think the NHS has got worse in the past five years.

The question that The Times and YouGov seem not to have asked/chosen to print is why people think service has got worse in the past five years. Another missing query is whether they felt the service had got worse in the five years prior to that and, again, what they felt were the causes of that decline. The polling did ask how well or badly those questioned thought the government was handling the NHS (57% said ‘very badly’ with a further 28% saying ‘fairly badly’).

The Times front-page story, bylined to columnist Rachel Sylvester (the ‘chair’ of The Times Health Commission), health editor Kay Lay, and policy editor Oliver Wright, says:

An analysis by The Times last week found that 50,000 more people than usual had died over the past 12 months, with NHS delays blamed for one of the most deadly years on record. 

It also quotes Matthew Taylor, chief executive of the NHS Confederation, former head of the No. 10 policy unit under Tony Blair, and old-school nepo baby broadcaster (his father is the radio presenter Laurie Taylor), who says:

The system is unaffordable as it is currently configured… We have to stop seeing health as this enormous hole into which we pour resources and realise that a healthier population is a more productive, economically active population. 

Yes, drones, we must be healthier for the benefit of Human Resources.

But in coverage spread across four pages — including a densely packed spread full of largely meaningless infographics — and a leader article, The Times ignores facts that the Financial Times’ John Burn-Murdoch summed up in a single paragraph back in December 2022:

And why are we not seeing this near collapse in country after country? Because the British government has underinvested in infrastructure for the best part of two decades. The UK’s overall health spending is not dissimilar to peer countries, but its capital investment is anaemic. Going into the pandemic, Britain had fewer beds per head than virtually any other developed country. One of the few country’s running a similar lean operation — Canada — has also suffered the ignominy of a midsummer ambulance crisis(opens a new window).

Instead, The Times focuses on coded calls for increased privatisation (“More entrepreneurial approach required”) and dismisses what it calls the “historical myth” of the NHS. In truth, the “reforms” of both Labour and Tory governments alike over the past 40 years have destroyed the fundamental promise of the NHS. Go back to Aneurin Bevan introducing the second reading of the NHS bill in 1946 and you’ll find that he said this:

I appreciate, as much as Hon. Members in any part of the House, the absolute necessity for having an elastic, resilient service, subject to local influence as well as to central influence

The foundation of the NHS was pragmatic and practical. Talk of myths is the product of columnists whose cure is rhetoric rather than medics dealing with the fatal now.

When Johnson said, “The NHS is the sacred cow of British politics,” 32 years ago, it was already a hoary old line. A brief search of recent columns and monologues finds it sliming from the chops of Matthew Syed (October 2021) Melanie Phillips (July 22) and Clare Foges (September 22) in The Times; Dan Hodges in The Mail on Sunday (November 22) Neil Oliver on GB News (January 23); Allison Pearson in The Daily Telegraph (January 2023 as well as many, many times before that); and Paul Baldwin in The Daily Express (January 2023). That’s by no means a comprehensive list.

The “sacred cow” idea is the real myth of the NHS. It suits columnists, leader writers and their editors to claim that the health service strolls serenely down the street with everyone diving out of its way, offering no criticism and demanding no change. The Nuffield Trust’s chief executive, Nigel Edwards, wrote in October 2022:

… the idea that this special status means it is not reformed and has not been copied elsewhere needs challenging.

Clare Foges recently articulated this commonly held misconception in The Times: “It is major surgery that is required, not an Elastoplast.... But politicians dare not say it because of the belief that the NHS is a sacred cow that cannot be slain, an institution so precious to the British public that any whisper of a rethink and pitchforked mobs will descend on Westminster.”

This somewhat nebulous and evidence-lite argument is undermined by the fact that the English NHS has been reformed remarkably often compared to other countries’ health systems. In the last 30 years alone, the governments of John Major, David Cameron and Boris Johnson each introduced a major overhaul to its structure, the role of the market and the role of the private sector, while Tony Blair’s government introduced at least two.

In fact, there is a strong argument that the NHS has had far too much reform – often badly designed and mostly focused on structures. The disruption, cost and loss of talent and organisational memory from these changes has been considerable. None have been independently evaluated, nor did any create structures or outcomes that were viewed as satisfactory. Very few of these changes have had anything to do with clinical care.

When newspapers, like The Times today, keep screaming, “The public is starting to lose faith in the NHS!”, they tend to use their familiar trick of pretending their own coverage plays no role in that. Deeply unserious arguments — like former professional ping pong ball botherer Matthew Syed comparing NHS funding to initiatives around Sport England or Keir Starmer kicking around half-truths about self-referral — are presented as sensible. Data is cherry-picked to ignore issues like underspending on capital projects and the loss of experienced staff in favour of focusing on dubiously calculated headline spending figures.

None of this is to say that the NHS isn’t in crisis or to claim that this particular crisis is not more profound than the periodic crises that have come before it. It’s incredibly hard to get a dentist appointment in England; ambulances queue outside hospitals; A&E departments are in a constant state of red alert; people are dying who should not be. But the claim that this is because the NHS simply cannot work is ideological and driven by a desire to see “free at the point of use” as a principle go the way of the horse and cart. When The Telegraph’s leader column says…

In order to fulfil the ambitions behind the 1948 dispensation, it was necessary to turn the NHS into a gigantic nationalised behemoth. While other state-run industries were privatised over the decades, the NHS retained its status as the untouchable institution, tinkered with at the edges but essentially left intact.

… it is not saying the quiet bit loud but showing that it has entirely given up on being quiet at all; it is screaming what it wants to see and that is private insurance for all but the most desperate. The most desperate can just have suffering.

The phrase “nationalised industry” is akin to the strongest of profanities to a Telegraph leader writer; it is an offence unto their god, The Market.

At the weekend, Shadow Health Secretary, Wes Streeting — who accepted a £15,000 donation from hedge fund manager John Armitage (who has major interests in private healthcare providers) in 2022 — told the i paper that the NHS is “is driven by provider interest, producer interest and not by patient interest.” The paper translated his quote into human for a headline that read NHS is too often run for doctors rather than patients and needs a decade to fix, says Labour’s Wes Streeting.

Back in 1991, Paul Johnson wrote:

There is an iron law of nationalisation from which the NHS is by no means exempt: public-sector industries are run in the interests of those who work for them, instead of those who use them.

In 2023, Labour’s health frontbench spokesperson sounds exactly like a Daily Mail column written when he was 8. The Overton Window is narrowing so quickly, you have to hope the NHS can find the capacity to deal with the extra head injuries.

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Thanks to Panicked_Future and John Hill for reading today’s draft.

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