British Health System Faces Critical Diagnosis

For five weeks, a 74-year-old woman with throat cancer waited for an operation at a state hospital. The woman’s surgery was postponed four times until, reluctantly, doctors had to tell her the cancer was now inoperable.

An 86-year-old man suffering from a serious heart condition lay in a hospital emergency room for more than 22 hours while staff members frantically searched for a vacant bed in a specialist ward.

A 49-year-old father of two remortgaged his house to pay $19,200 for a quadruple heart bypass operation at a private hospital, rather than join the government’s 14-month waiting list for such surgery.

Every day seems to bring another tale of woe for Britain’s National Health Service, the 51-year-old institution created to provide every resident--regardless of income--free health care from “cradle to grave.”

The service’s surgical waiting lists are long, and often made longer by last-minute cancellations and postponements. Weeks elapse between an initial doctor’s appointment and a consultation with a specialist.

Hospitals don’t have enough beds, particularly for emergency patients, and doctors and nurses work long hours for low pay.

The British media have declared the National Health Service in a state of crisis and contend that Britons have it worse than nearly all their European counterparts--even Poland, The Mirror announced with some horror.

Few Call for U.S.-Style System

Opinion polls say that the public shares the media’s disillusionment, with well more than a majority describing the service as “in somewhat failing health” or “very poorly indeed.”

“I’m not going to sit here and say there aren’t problems in the NHS because there are, and we’ve got to put them right,” Prime Minister Tony Blair conceded in a British Broadcasting Corp. television interview as he pledged billions in new funding.

Created in 1948, the National Health Service was considered a shining example of working socialism. By guaranteeing free health care, it embodied equality and was embraced not only by the leftist Labor Party but reluctantly by the right-wing Conservatives.

Even amid the current crisis, few people dare call for the complete dismantling of the health service in favor of U.S.-style privately funded medical care.

“Something in the British soul revolts at the idea that one man, because of his greater financial resources, should be able to buy himself better health care, and a longer life, than his neighbor,” conservative columnist Boris Johnson wrote in the Daily Telegraph.

But the years have taken a toll on the NHS. Britain’s population is getting older, and patients’ expectations are rising. Expensive new treatments also are gobbling more and more of the health care budget.

For many, the solution is simple: Pour in more money.

Blair’s government attempted to do just that March 21 by spelling out details of a huge financial boost for the National Health Service as part of the government’s annual budget message.

Treasury chief Gordon Brown pledged to raise health spending by 6.1% over the inflation rate in each of the next four years. By 2004, the Health Service’s annual budget will be nearly $31 billion higher, at about $108 billion.

Britain now allots about $77.4 billion a year to health care, or about 6.8% of its gross domestic product. That compares to a European average of 8%, about 10% in Germany and France, and about 13.5% in the United States.

The new spending will bring Britain closer to the average European level, but some argue that money isn’t enough and more radical change may be needed.

“Money is welcome, but the trick is what you are actually going to do with it,” said Andy Bell of King’s Fund, an independent health care charity and think tank. “You can’t just put money into it and see what happens.”

Bell remains wary of suggestions for the health service to increase cooperation with the private sector, but calls are growing for greater private-public initiatives.

Already, the private sector plays a large role. According to the Independent Healthcare Assn., which represents private providers, it supplies 443,000 hospital beds, compared with 356,000 by the NHS and local health care authorities.

In Britain, about 13 million people have chosen to make some form of private provision for their medical care, nearly a fourth of the overall population of 56 million.

“The NHS is treasured,” said Peter Fermoy, communications director of the Independent Healthcare Assn. “But growing numbers are increasingly unhappy that the NHS they cherish is unable to deliver the service that they and their predecessors came to expect.

“I think the time is right for a partnership. We are, after all, in the same business.”

Suggestions range from paying the private sector to perform some nonemergency surgery to allowing some NHS hospitals to be run privately, thereby increasing competition.

Fermoy said the private sector has hospital beds that the National Health Service could use in a time of crisis, if the government would only send patients their way.

He also noted that private companies have 400,000 nursing home and residential care beds that could serve elderly patients who require some nursing care but not intensive hospital attention. That would free up beds throughout the health service for surgery and crisis patients.

The opposition Conservative Party has suggested that the government offer tax breaks to individuals who take out private health insurance, an idea flatly rejected by Blair.

“The way to do it is to modernize the National Health Service, not privatize it,” the prime minister said during a recent House of Commons debate.

Advocates for the NHS say that the public health service is the only way to ensure that all people--no matter their income--have access.

“The poorest people suffer the worst health, but they are not the people who would be in a position to take advantage of private health care,” said Bell, of the King’s Fund. “There is a danger in seeing the private sector being a panacea to all our problems.”

Government Commits to Shoring Up NHS

Brown, the treasury chief, said the planned increase in funding--which includes an extra $3.1 billion for this year--is a sign of the government’s determination to bolster the aging British institution. Plans also are underway to recruit 10,000 nurses.

“This government is committed to a publicly funded NHS, true to the original principles of its founders,” Brown told lawmakers.

But health leaders warn that the long waiting lists, seemingly endless delays and crowded corridors won’t disappear overnight.

Blair “has made a very public commitment to a publicly funded NHS and put his money where his mouth is,” said Stephen Thornton, chief executive of the NHS Confederation. “But one of the things that we have all got to do is to be clear that, although we have got very significant additional resources, it is going to take time to turn this tanker around.”

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On the Net:

Department of Health: https://www.doh.gov.uk/dhhome.htm

Independent Healthcare Assn.: https://www.iha.org.uk