The Doctor Won’t See You Now: The UK Cost of Survival Crisis

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There is no shortage of grim headlines in the UK at the moment. Britain is facing a dire cost of living, a steady pace of strikes and potential blackouts this winter. So here’s another happy thought: The breaking point for this government could be a crisis in the cost of survival.

A certain amount of pain from rising energy prices can be absorbed with the appropriate level of government intervention and messaging (okay, neither is in evidence yet) . Brits can summon the “spirit of the blitz” to turn down the heat in cold months, throw on an extra layer and run fewer washing machine cycles. But hell has no fury like a population that has no access to health care.

The prized and troubled National Health Service now has a backlog of 6.6 million patients waiting to see GPs, get scans or undergo operations. Liz Truss and Rishi Sunak, the two candidates vying to replace Boris Johnson, have both vaguely pledged to fix the issue, but have spent most of the campaign arguing over tax cuts.

Arrears are not new. Even before the pandemic, the queue stood at 4.43 million awaiting care. Despite some recent progress, there is still a huge way to go. The number of patients waiting more than a year for treatment has increased 13 times, according to the British Medical Association. In 2012, less than a fifth of people said they had trouble making an appointment with their GP; now it’s 47%. More than a quarter avoid making an appointment at all.

More people are dying because they cannot get timely care. Ambulance response times were among the fastest on record – and that’s before the real crunch of winter hits. Victims of heart attacks, burns and other emergencies are not treated in a humane or reasonable time frame.

Then there are the countless stories of people living in excruciating pain for months or years while waiting for hip replacement surgery or a diagnosis. The near impossibility of getting NHS dental care has led some to resort to extreme measures to get relief.

The lack of cancer care is particularly devastating. One in two people will develop some form of cancer in their lifetime. In my immediate family, I have seen three cases over the past decade. In my friendship group, there were several. Detected early and well treated, the survival rates of many cancers are very encouraging. But while cancer care in the UK has improved in recent years, it has long lagged behind other major countries when it comes to one- and five-year survival rates for many major cancers.

In Britain as elsewhere, Covid has wreaked havoc on cancer diagnosis and treatment. Doctors now say expectations for both are at dire levels and many people will die from them.

The country’s health problems have been compounded by labor shortages. Across the NHS there are currently 110,000 vacancies. England alone urgently needs 12,000 more hospital doctors and around 50,000 nurses.

Burnout is a huge problem, with more young doctors leaving before completing their training and more doctors retiring early, going into private practice, or considering leaving. Almost one in five nurses who quit cited job pressures or stress as the reason. Brexit has also reduced the number of EU-trained nurses and doctors in the UK, leaving hospitals to recruit farther afield.

All of this doesn’t even touch on social care – the fragmented and underfunded support system for everything from autism to dementia to other long-term needs. The 1.5% increase in the National Insurance Tax (a social security tax) paid by employers and employees was billed as funding for social care, but its immediate purpose was to try to reduce the NHS waiting list. Truss wants to reverse it anyway. Funding an adequate welfare plan will likely require around 0.5% of GDP, but no Conservative candidate has committed to that.

Like the cost of living crisis, the health care crisis requires immediate and longer-term solutions. The immediate challenge is to get people who need care into the system before delays worsen pain and cost more lives. The only answer is the most obvious: more funding and more recruitment of labor outside the UK.

It will also require more contracts with private sector healthcare providers, as has been done successfully in many places during the pandemic to ease pressure on NHS hospitals. The dirty little secret of the British state system is that it would collapse without the private sector, which has provided excellent services in orthopaedics, audiology, ophthalmology and other fields.

Both Truss and Sunak talk about boosting economic growth, but that won’t happen without solving these NHS problems. Long waits for treatment compromise productivity as well as quality of life.

Yet pouring ever-increasing sums into the NHS is both unsustainable and inconsistent with the Conservative vision of a low-tax state. Longer term solutions are needed.

There are alternative models of universal health care delivery in other countries – such as those in the Netherlands and elsewhere that use public and private insurance to provide high quality care. The fact that so many Britons who can are dipping into their disposable income to pay for private care suggests a willingness to compromise. Asking people to pay a nominal fee to see their GP (with exemptions for the poor) would likely reduce missed appointments and unnecessary visits with no material impact on household finances – and it would help fund more complex needs such as cancer care.

Any real solution will involve compromises, both financial and political. As a friend told me, the British NHS resembles the old Soviet economy; anything you do to fix it will almost certainly shock it into non-performance. Even so, inaction is killing the patient, and any hope the Conservatives have of winning the next election.

This column does not necessarily reflect the opinion of the Editorial Board or of Bloomberg LP and its owners.

Therese Raphael is a columnist for Bloomberg Opinion covering health care and British politics. Previously, she was the editorial page editor of The Wall Street Journal Europe.

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