Socialism Kills

Most people think Britain didn't have a health service before the NHS. In fact, it was the envy of the world. So why did we throw it away for a system that kills its own patients?

Daily Mail

22 November 2004

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The welfare state is a political sacred cow - but an important new book claims that Britain would have been better off if it had never been created. Here, in our second extract, author James Bartholomew argues that the NHS is a disaster that, far from improving health care, has wrecked it...

Many people today seem to think that healthcare hardly existed before the NHS arrived in 1948 - except for a few hospitals that treated the rich, perhaps.

But if this is true, why were the British hospitals at the forefront of developing new drugs like penicillin?

The reality is that British medical care prior to the NHS was far more impressive than most of us realise. All the great London teaching hospitals were founded before the NHS - indeed, St Bart's, one of the most famous, dated back to the start of the 12th century, when Augustinian friars began caring for the sick at their priory.

Many hospitals were founded in the 18th and 19th centuries, when benefactors who included contemporary celebrities such as the compose Handel and Joshua Reynolds, the artist. They were regarded with envy around the world.

By the start of the 20th century there was a vast network of hospitals across the country, treating the rich and poor alike and making breakthroughs that are still saving countless lives today.

The difference is that back then the system wasn't run by an army of state bureaucrats or paid for by massive, centralised taxation. It was largely paid based on charity.

The development of penicillin was supervised by Sir Howard Florey and his team at the Dunn School in Oxford, where the crucial, most expensive stage in their work was funded by the charitable Rockefeller Foundation.

The building in which they worked was funded by charity (from a bequest by Sir William Dunn, a wealthy Scottish philanthropist) as was St Mary's Hospital in Paddington, London, where penicillin had been first noticed 13 years previously by Sir Alexander Fleming.

Fleming was able to make that breakthrough only because St Mary's existed and gave him the opportunity to do his research. Like countless other charitable or 'voluntary' hospitals, it relied for its survival on donations, legacies, fees and fund-raising drives.

The great and good contributed, but so did the ordinary people - through Sunday collections in church and Saturday collections in workplaces.

Those who could afford it paid for their treatment, often by subscribing to regular hospital care plans, but those who could not afford it were treated, too. This is what being a charitable hospital meant.

Indeed, inconceivable as it may seem today, it was normal for consultants to work for a large proportion of each day without charge, to ensure than the needy didn't miss out.

Frederick Nattrass qualified in 1914 and, after the war, began working at the Royal Victoria Infirmary in Newcastle upon Tyne. He eventually became a consultant neurologist there.

His daughter, Anne Whittingham, remembers his routine: 'He went to work at the hospital in the morning - all for free, because it was a charity. Then, to get an income, he took private patients at our home in the afternoon.

'This wasn't unusual. All his friends did it. All consultants did.'

There were also hospitals run by local authorities, in which local people took considerable civic pride, but by 1936 the voluntary hospitals took 60 per cent of patients requiring acute care.

It wasn't a perfect system - none is - but it worked. There were surely some poor people who received inferior treatment or none, but the vast majority got the care they needed - in many cases from the top specialists of the time.

So what did Clement Attlee and his colleagues in the Labour Party do in 1948? They threw it all away.

Attlee appointed Aneurin Bevas as Minister of Health. Bevan was a brilliant, neo-communist firebrand and set about creating the most state-controlled medical service outside the Iron Curtain. Eight centuries of development of British medicine was junked for an ideological socialist dream. Bevan pushed aside the passionate objections of the medical professional with all the ruthlessness of a man whose thinking was rooted in Marxism.

Looking back, what's astonishing is how little evidence he produced to discredit the old system. The Labour Pary pamphlet that recommended a 'National Service for Health' in 1943 could find little to criticise.

There was mention of only one waiting list, for 'rheumatic diseases', adn even this was confined to a footnote. There was no suggestion that waiting lists were a problem in any other specialty.

There was not a word against the quality of care, and no claims that people were dying or incapacitated because they couldn't obtain treatment. Far from being condemned, the charity hospitals were praised for having 'rendered great service'.

So why change everything? Because, the pamphlet said, a good medical service had to be 'planned as a whole'.

The old system was 'unplanned' and 'a medley of public and voluntary institutions'. Never mind how effective it was - it offended the socialist principle of central control. It had to go.

Of course, Bevan, Atlee and the rest meant well. They intended no harm. But harm is what they did. They produced a monolithic system that was grotesquely rigid, wasteful and inefficient.

In its first 50 years, in the name of 'mergers' and modernisation, hundreds of hospitals were simply closed. Many were local hospitals, that - quite contrary to what Labour had promised during the war - people were left further away from their nearest hospital instead of nearer. Tens of thousands of hospitals beds were carted to the dump.

The standards of accessibility of British medicine slumped. From being one of the best countries for medicine among all the advanced countries of the world, we declined and became one of the worst - arguably the very worst.

Look at almost any measurement of the quality of medical service and you know find Britain in the bottom half of the table. In one comparison of the proportion of people surviving lung cancer five years after diagnosis, Britain came last, below Estonia.

According to the World Health Organisation, British men are also more likely than those in comparable countries to die of coronary heart disease before reaching 75. We suffer 265 deaths per 100,000 people - against 200 in Germany and 171 in Australia.

Worrying and depressing figures like this are hardly surprising. Thanks to its rigidities of structure and funding, the NHS lacks everything. It lacks doctors. It lacks nurses. It lacks the latest equipment.

Take CT scanners, which help doctors diagnose cancer. Recent figures showed that Japan, despite its relatively low spending on medical services, had 84 of them per million of population. Australia had 20.8, Germany had 17.1, and the United States had 13.2. The average for developed countries was 12.

Britain, by contrast, had only 6.1 - fewer than Turkey or the Czech Republic.

What equipment we do have is old and sometimes even dangerous. Dr Colin Connolly, a former chief scientist at the Department of Health, found that more than half of the NHS's X-ray machines are past their safe life span.

More than half the anesthesia machines need replacing, as do half the machines used for intensive care. About a fifth of the equipment used in cancer care if obsolete, and the majority of operating tables are over 20 years old - more than twice their safe time limit.

THe NHS gets the latest drugs and treatments later than other countries and in smaller quantities. Virtually all the most exciting work on new medical breakthroughs - stem cell technology, gene therapy, the search for a cure for heart disease - is being led [by] the Americans. Britain, the country that developed penicillin, is now just a bit player.

Notoriously, the endemic shortcomings of NHS treatment are controlled by rationing in the form of waiting lists. And despite all the political propoganda that has been pumped out in recent years, these lists are still of a length unknown in any other advanced country.

The result is that the poor get inferior treatment to the rich - who can afford to go private - and are thus more likely to suffer and die. This in a system that is already causing thousands of needless deaths a year.

That may sound shocking, but look at the facts. Because the treatment of cancer under the NHS is so far below the average standard in Europe, Professor Karol Sikora, a cancer specialist at London's Hammersmith Hospital, has estimated that 10,000 people a year die prematurely in Britain.

Add the number killed by preventable hospital infections, and our atrocious record on infant mortality (we have the worst figures in Europe) and the total instantly rises to around 15,000 deaths a year directly attributable to the NHS under-performing other systems.

This leaves out blunders committed by over-stretched staff and poor standards in other specialties such as coronary care. Yet even at this bare minimum, the NHS is killing the equivalent of a Paddington rail disaster every day.

None of this should be taken as criticism of the doctors, nurses and other front-line staff, whose enormous dedication and humanity is all the more remarkable given the circumstances they work in. They, too, are victims of a terminally bureaucratic and unwieldy system.

Some people will say: 'Ah yes, but it will be all right now. Labour is putting lots of money into it.' Yes, more money is going in. The extra money is raising the amount spent on the NHS in England up to the same proportion of output as that spent on healthcare in Scotland.

But do we want Scottish levels of healthcare? Certainly not. The Scottish NHS is no better than the English. It is far below the standards of France or Switzerland.

There is simply no escaping the fact that the NHS has been a disaster for Britain. Millions have been treated late, been left undiagnosed, been left on waiting lists, suffered or even died. It has been one of the most catastrophic aspects of the welfare state.