Emily Carver is Head of Media at the Institute of Economic Affairs.
The recent furore over the proposed one per cent pay rise for NHS staff has served as yet another reminder of just how toxic and claustrophobic public debate over our health service has become.
Unsurprisingly, the press framed the Government’s decision as a callous attack on nurses (despite the fact that the pay rise would apply across-the-board), the unions slammed the “pitiful” increase as “the worst kind of insult” to NHS workers and threatened strike action, while the opposition rallied to demand justice for our “Covid heroes”. All very predictable. But while the headlines may have been foreseeable, it is still troubling to see how little room there is for rational discussion when it comes to “our NHS”.
First, it doesn’t take much digging to discover that the headline figure of one per cent is misleading. The wage banding system for NHS staff – as with most of the public sector – allows for regular incremental wage rises; and overtime payments and extra allowances for staff in London and the South East are also built into the system. The problem is that the way staff are remunerated appears arbitrary and allows little room for targeted or performance-based pay rises.
In an institution, which employs 1.3 million people, this is not only an inefficient way of using taxpayers’ money, but a rather unfair and possibly demotivating method for deciding pay. Few would disagree that pay should ideally reflect contribution and performance, rather than rely on national pay bargaining. It is distinctly disingenuous to claim that every single employee in the NHS, regardless of their role, responsibility or competence, deserves the exact same increase.
For now, fundamental change in the way we decide NHS pay is likely to be placed on the backburner, along with reforms to many other areas of public policy. Far simpler for ministers to slap an NHS badge on their lapel and squabble over how many extra billions we should pump into the behemoth this year. Why risk the inevitable backlash that comes with calling for more substantial reform?
It was only a few weeks ago that the IEA’s relatively innocuous briefing paper Viral Myths, which challenged the idea that the NHS has been a “star performer” during the pandemic, triggered explosive media coverage. The fact that the paper made it clear that it was talking about the institution rather than the staff mattered very little when the opportunity arose for politicians and commentators to make incendiary remarks – see Angela Rayner’s public outburst for a particularly wearying display of point-scoring.
I have written to @MattHancock demanding that he repay the donations he has received from the Chair of the IEA following their report disgracefully attacking the NHS and NHS staff saying that there is "no reason to be grateful" for the NHS and NHS staff don't deserve our thanks. pic.twitter.com/Ti0F5PfI2F
— Angela Rayner (@AngelaRayner) February 9, 2021
It is clear that much of the political class would rather pander to the narrative of the NHS as the “envy of the world” than stick their head above the parapet and dare to suggest we might have something to learn from international best practice.
But this is cowardly at best and sinister at worst when you consider that the NHS consistently ranks in the bottom third in international comparisons of health system performance, which, to our shame, translates into thousands of unnecessarily lost lives each year. Failing to implement – or even entertain the notion of – change helps no-one, aside from perhaps a handful who use it for cheap populism. Reform would not undermine hard-working staff, quite the opposite. Releasing frontline staff from the broken system they are trapped within would be a mark of respect and gratitude.
In the months to come, the case for reform will strengthen. As immediate pressure from Covid patients eases, it is doubtful the NHS will breathe a sigh of relief. It has been estimated that as many as six million “hidden” patients could join the queue for NHS treatment in the coming months, which could see waiting lists reach eight million by October this year. The reported rise in the number of people now booking private appointments suggests that the public are growing increasingly aware that the service is in poor health, and increasingly impatient at how long it takes to get the treatment they need. If this trend continues, as is surely inevitable, it is not inconceivable that resentment will start to bubble at the vast sums funnelled towards an unreformed NHS.
Although the pandemic has exposed systemic weaknesses in the NHS, people appear intolerant to change. Such is the potency of the two rhetorical strawmen devotees of our healthcare system are able to erect: first, that criticism of the institution is tantamount to criticism of its workers and second, that the only alternative to our universal provision is the American system. But perhaps, as the trauma of the pandemic eases, their resolve may soften. Either way, our representatives owe it to us (let’s remember the NHS budget is likely to reach a colossal £200 billion this year) to engage in sensible discussions over reform.
It is simply unacceptable that it is now the norm for patients to wait months and months for routine operations – as was the case even before the pandemic struck. The UK is the fifth largest economy in the world; it should be a national scandal that our health service produces health outcomes more similar to that of the Czech Republic and Slovenia than of Switzerland or Belgium, both of which, it is important to stress, benefit from universal market-based healthcare systems.
The burden on the NHS in the months and years to come may be unlike anything we have yet experienced. The Government speaks of a global Britain, but this must include a willingness to learn from other countries, and healthcare should be no exception. Those hackneyed arguments that any failings are down to underfunding, or that the only other choice besides the NHS is the US model, are borderline insulting to a voting public who have sacrificed so much over the past year to “protect the NHS”.