Britons took to the streets to applaud NHS workers. As part of the fight against the coronavirus epidemic, the UK has become the most vaccinated country in Europe, and many believe this is due to the National Health Service (NHS) healthcare system. However, until the successful mass vaccination program over the course of a year, Britain led the world in the number of COVID-19 deaths per 100,000 population. The government, Prime Minister Boris Johnson, and sometimes scientists, but not the NHS, have been blamed for such a sad statistic.
It’s not just about respect for British doctors: it’s about love, emotional attachment and state medicine. Paul McCartney and actress Emma Thompson wrote love letters to the NHS, which were published in 2020 alongside dozens of other letters of gratitude to the British healthcare system.
The posters say “NHS, we love you”, “NHS, you are gold”. Children draw a rainbow – the emblem of the NHS – on the asphalt, while their parents hang posters praising the NHS in the windows of their homes. During the pandemic, half a million volunteers signed up to help the NHS. During the peak of the pandemic last year, every Thursday at exactly 8:00 p.m., Britons left their homes to applaud NHS workers. “Other European countries have social insurance systems that provide almost universal healthcare, but their citizens do not have the same affection for their medical system,” says Professor Robert Bivins of the University of Warwick, one of the authors of the project on the NHS as part of British culture. But despite this infatuation, the British constantly complain about their health care system. BBC Russian Service examined the limits of this unconditional love for the national health system and its reasons.
The future Queen Elizabeth II, then just a princess, visited an exhibition on health care in the United Kingdom in 1948. The 2018 public opinion poll found that among the country’s public institutions, the NHS is more popular than the Queen and the BBC. “NHS is what unites us, what we don’t have to doubt. We don’t have to pay for health insurance and NHS is always with us in the most difficult moments,” says Karl Flynn, one of the organizers of the 70th anniversary celebrations of the NHS in 2018. “The principle of the NHS is very simple – free healthcare for everyone, regardless of the size of their wallet,” adds Flynn. “Whether you are a queen or a commoner, access to healthcare should be equal. It should not depend on your income, but on your needs,” says John Appleby, head of the Nuffield Trust medical foundation.
Secretary Bevin (center) led the creation of the NHS. “The sense of collective responsibility that developed strongly after the Second World War continues to influence our attitude to the NHS,” says John Appleby. This responsibility of the state for the health of the population is reflected in the fact that there is no separate tax for the NHS in Britain. The National Health Service, like education and other vital services, is funded out of the “public purse” – general taxation. British people do not have to pay for health insurance and do not have to worry about it when they change jobs. Research shows that only 13% of Britons have private health insurance. The majority of such policies are provided by employers, meaning that Britons do not actively seek out private health insurance. At the same time, none of them provide the same level of service as the NHS.
Part of the London Olympics opening ceremony was dedicated to the NHS. The British pride in their own health system and emotional attitude to medical services may seem strange to foreigners. The Opening Ceremony of the London 2012 Olympic Games was designed to showcase Britain’s finest achievements, the objects of its greatest pride. It featured James Bond and the Queen. But alongside them, as part of the ceremony at the London Stadium, children jumped on hospital beds and nurses in uniform danced and handed out medicine. Doctors in white coats danced with patients. “From the beginning, the aim of the NHS has been to create a more equal society where everyone has access to healthcare,” says Professor Robert Bivins. “The NHS has become part of the national idea that Britain is an equal and open society. And the symbol of that society is the NHS,” says the professor.
With the establishment of the NHS in Great Britain, infant mortality decreased significantly. We explain quickly, simply, and clearly what happened, why it matters, and what happens next. The number of episodes should not be changed. End of podcast advertising story. The NHS was founded in 1948 when the Labour Party, led by Clement Attlee, was in power in Britain. Attlee had won the election three years earlier, defeating Britain’s wartime leader, Winston Churchill. The Minister of Health in the Attlee government was Aneurin Bevan. He also led the work on the creation of free state medicine. NHS education was part of the policy of forming the so-called welfare state, in which the state takes care of the well-being of its citizens “from the cradle to the grave”. At that time, in the hungry post-war years, not only free health care but also free education was introduced. “The policy of the Labor Party at that time was to fight five “giants”. One of them is disease,” says Roberta Bivins. Other “giants” that the British authorities fought against after the war were poverty, poor housing conditions, lack of education, and low employment rates among the population. The nation’s health was in terrible shape after the harsh war years, and there was a huge public demand for an affordable health care system to treat and maintain health. As early as 1951, it became clear that the government couldn’t afford to pay for all the costs of the NHS, and a standard prescription charge was introduced, regardless of type or cost. Today, this fee is just over £9 (about $12) in England, but many of the most vulnerable people are exempt. In addition, medicines are free in other parts of the UK – Wales, Scotland and Northern Ireland. Payment for ophthalmic and dental services was then introduced. Children up to the age of 18, the elderly, pregnant women and mothers in the first year of a child’s life are exempt from the NHS system. “The British saw the creation of the NHS as something they deserved after all the hardships of the war. The NHS became a compensation for the suffering endured during the Second World War and for the social inequality that the war demonstrated,” says Roberta Bivins.
The love of the NHS is instilled in the British from childhood. In her words, the NHS reminds the British people of what it means to be British. It has become an issue of national pride and what unites the British. The 2020 poll found that 71% of people are proud to be British, largely because of the NHS. In second place in the survey was the British national dish, fish and chips, which 58% of respondents were proud to eat, followed by a full English breakfast (52%) and then the Queen (48%).
The majority of Britons think the NHS is doing a good job. Surveys also show that the majority of Britons are generally satisfied with the public health system. Some 63 percent of the population think the NHS works well. The majority of Britons believe that hospitals are working well (68% of respondents responded positively), and 64% of respondents praised the work of general practitioners. The number of people dissatisfied with the National Health Service (NHS) fell from 30 percent in 2018 to 25 percent a year later. Studies have shown that the level of satisfaction with the NHS depends on age, gender and political views. People over 65 are more satisfied with the NHS than younger Britons. Supporters of the current Conservative Party are more satisfied with the NHS (68%) than supporters of the Labour Party (57%). In 2019, nearly two-thirds of respondents (62%) said they were dissatisfied with the lack of staff in the NHS. More than half of respondents (57%) complained about long waits to see a doctor. And nearly one in two (49%) said they were generally dissatisfied with the lack of government funding for the health service.
At the first appointment with a general practitioner, the patient usually has no more than a quarter of an hour to complain about all their ailments. “When we did our research, the British often told us that they loved the NHS. And then they would list a hundred complaints about the way the NHS works,” says Professor Robert Bivins. Where does this mix of love and willingness to complain about their health care system come from? The NHS is most effective when people need emergency medical care. “The British know that if their car hits them, they will be taken to the hospital immediately and receive the highest level of service in the world. And all of this is absolutely free,” says Roberta Bivins. “The NHS is very successful in providing support at key stages in our lives: childbirth, adolescence, pregnancy and the treatment of serious or acute illness,” she adds.
The NHS has been shown to be highly effective at key stages in the lives of British people. According to Bivins, these are all very emotional moments in our lives, and this partly explains the British “infatuation” with their healthcare: “During these emotionally crucial moments in life, state medicine in general tends to be at a high level. But at all other times, when all other services provide almost instantaneous assistance, people are annoyed by the need to wait. “You have to wait to see a local doctor. You have to wait for a hip replacement. You wait and you wait and you wait and you wait,” Bivins says. Currently, during the pandemic, waiting times for non-urgent surgery or non-urgent specialist consultations have increased from 4 months to 18 months. A recent study showed that more than 160,000 British people have been waiting more than a year for non-urgent surgery. The total number of patients waiting for surgery will exceed 4.4 million by December 2020. We have to wait because there is a shortage of doctors and nurses and a shortage of hospital beds. When the National Health Service was created in the post-war period, its role was to help people at key times in their lives and when they were seriously ill. The NHS is still doing this and the results are obvious. For example, in 1948, 36 out of every thousand newborns did not live to see their first birthday; today, that figure is four out of every thousand. Since 1948, the average life expectancy of Britons has increased by 13 years. “In 1948, nobody really thought about chronic diseases or, for example, providing medical services for obese people. And now we think: I have flat feet, I need to see a specialist,” says Roberta Bivins. “Now we want the NHS to help us, whether it’s moving by bus or having ingrown toenails,” she adds. “But the NHS doesn’t deal well with ingrown toenails.” And like everywhere else, healthcare costs are rising, partly due to the development of new drugs, diagnostics and treatments. The UK population is ageing. All of this is driving up the cost of the NHS.
British doctors try not to refer patients for expensive diagnostic procedures when there is no real need. Britons have to wait to see a specialist or for non-urgent surgery because of the NHS’s limited resources, which have been deliberately chosen to focus on urgent and serious health problems. NHS – one of the most affordable healthcare systems in Europe. “We spend less on health care than many other European countries. So we all get the medical care we need, but no one gets the NHS service we would like,” Professor Bivins explains. “For example, I would like to have an MRI to see what is going on in my body, but the NHS cannot afford to do expensive scans just out of curiosity,” she adds.
British doctors often complain about work overload and bureaucratic dominance. The NHS is one of the UK’s largest employers and working in the NHS is prestigious. However, doctors complain about bureaucracy and overwork. The paradox is that despite the prestige and high salaries, half of the doctors surveyed said they were considering leaving the public health system for private practice or significantly reducing their working hours.
Despite complaints and dissatisfaction, thousands of Britons went out every week during the first quarantine to express their gratitude to the NHS. The UK lags behind other European countries in some parameters of health care efficiency. In 2015, the UK ranked 10th out of 28 EU countries for male life expectancy and 17th for female life expectancy. Before the current pandemic, 80% of premature deaths in the UK were due to cancer and cardiovascular disease.
And if British men suffering from cancer and cardiovascular disease live longer on average than the average European, among women the indicators of cancer treatment were worse than the average indicators of the European Union.
In Sweden, the health care system is similar to the British system, it is financed in the same way as in Britain. But the Swedes do not love their medical system. “In Sweden, socialist parties have controlled the country for half a century, and Swedes are confident that no one will take away their free health care,” says Professor Robert Bivins.
“Our research into the history of the NHS has shown that British politicians make it seem as if the NHS is always on the verge of collapse. From its inception, the NHS has become part of the political football,” says the professor.
The Brexit campaigners used the NHS issue vigorously in their political campaign. Since the late 1940s, the future of the NHS has always been debated during elections, Professor Bivins notes. When the Conservatives are in power, Labour fears that the Tories will privatize the NHS. But when Labor comes to power, the Conservatives warn: watch out, Labor is wasting money, funding the NHS, the budget cannot handle it.
“The public is being led to believe that the NHS could disappear at any moment,” explains Roberta Bivins. “By 1952, politicians realized that no party would dare end the existence of the NHS because of the popularity of free, state-funded health care. But in the press and during election campaigns, they would tell people: you know, the NHS could be privatized at any moment,” Bivens explains.
According to the professor, this fragility, inconsistency, and the fact that the NHS has become a symbol of equality in society explain the British people’s infatuation with public health care. And the government uses that love.
In the midst of the epidemic, the country’s authorities urged residents to stay indoors to protect the NHS and save lives. “Stay at home, protect the NHS, save lives” – this was the slogan of the first quarantine caused by the pandemic in March 2020. One of the main slogans of the Leave campaign was the transfer of NHS funds that Britain pays into the EU fund (£350 million per week). This figure turned out to be implausibly inflated, but it is interesting that Brexit supporters chose NHS funding as one of their arguments.
Brexit opponents, meanwhile, fear that the government will enter into private contracts with American companies that will sell NHS drugs and equipment at triple the price. None of the UK’s political parties will risk cutting health spending, and during election campaigns politicians of all stripes swear that only they can ensure a secure future for the NHS. And yet the NHS has failed to solve one of its main problems. Equality of access to health care, it turns out, does not guarantee equality of health status.
Despite the best efforts of the NHS, successful and wealthy Britons continue to live healthier and longer lives than those from poorer backgrounds. In 1980, the British Ministry of Health published the so-called “Black Report”, which was prepared by a committee of experts headed by Sir Douglas Black. The report showed that the mortality rate of working class men (class V) was twice that of privileged (in their terminology – first) class men. The report also showed that these health inequalities have increased rather than decreased since the establishment of the NHS. The authors of the report concluded that this was not due to the shortcomings of the NHS, but to social inequalities in income, education, housing, nutrition, working conditions and levels of unemployment. Today, this difference in life expectancy between Britons of different income and social status is nine years for men and seven years for women. It turns out that access to health care does not guarantee the health of a nation divided by class and social factors. Regional inequalities persist.
In the wealthier areas of southeast England, health indicators are much higher than in the poorer north of the country. The coronavirus epidemic also revealed population inequalities. The poor, migrants and ethnic minorities proved to be more vulnerable during the pandemic. At the same time, COVID has shown the strengths of the NHS.
The NHS is quite effective at handling mass vaccination against COVID. “By working together, the regions were able to cope with the huge influx of patients into hospitals,” says Jennifer Dixon, head of the Health Foundation, a charity dedicated to improving healthcare for UK citizens. “Never before in its history has the NHS been under such pressure,” explains Dixon. “In January this year, British hospitals were receiving 4,000 patients a day. That’s like filling four hospitals every day. We were simply not prepared for a crisis of this magnitude. “The main reason for the high number of deaths from COVID-19 is that the government did not respond quickly enough to the pandemic,” explains BBC science correspondent David Shukman.
“Some countries were quick to implement social distancing and other measures. The countries where an epidemic of atypical pneumonia occurred in 2002-2004, as well as those affected by the Ebola epidemic, were better prepared for the current pandemic,” – adds Shukman. “In these countries it is easier to quickly set up a system to trace the contacts of infected people,” said Professor Sophie Harman of Queen Mary University in London in an interview with the BBC. “Britain closed its borders too late. New Zealand and Australia closed their borders immediately, reducing the risk of infection being brought in from abroad.” In addition, unlike many African countries, Britain’s population is aging. A significant number of Britons suffer from obesity. Both age and obesity increase the risk of complications and death from Covid-19 infection. In admiring their healthcare system during the pandemic, the British made a clear distinction between the NHS system itself (hospitals, general practitioners, emergency medical services) and the Department of Health.
Unlike in the Soviet Union, doctors in Britain are free from direct state control. “From its inception, the NHS has been run in such a way that the government cannot directly interfere with the work of doctors. The government and the Secretary of State for Health can change the budget of the NHS, but that does not mean they can directly dictate how that money is spent,” she explains. “From a social point of view, this would be unacceptable. We do not trust politicians. We trust doctors,” says the professor. She says that in the 1970s, a commission was created in the United Kingdom that sent researchers to different countries around the world to study their health care systems. You also visited the Soviet Union. “They were very impressed that the USSR was creating specialized medical centers. This seemed very modern and progressive to the English,” the professor said. “But the expert group was concerned that in the USSR the state could control doctors. Such control is totally unacceptable in Britain,” she adds. “The thing is, the NHS cannot be marinated. What was normal in the ’40s is totally inadequate for today’s needs,” says former health secretary Alan Milburn.
The British love affair with the NHS is not always rational. Could it be that the British love affair with the NHS is holding back improvements in British healthcare? “We have become too complacent about the problems within the NHS,” says Professor Robert Bivins. “Not all love for the NHS is rational. We continue to think, out of habit, that everything is perfect in the NHS and we stop asking questions about how this system can be improved. For example, we should ask more often how we can reduce the number of people dying from cancer and improve cancer diagnosis,” the professor adds.
She believes Britons should ask themselves more often whether the NHS needs more money or better organization.
A more responsible attitude to health and health care will ultimately help to reduce the burden on the NHS. The expert believes that the NHS is treating people who feel generally healthy very poorly. “It is difficult for us to get an appointment with a doctor. When you see a therapist, you only have 5-10 minutes to talk to him. It’s not very pleasant to go to the local doctor, and you have to wait a long time to see him,” she explains. “And it is at this level of primary care physicians that cancer can be detected earlier. If we want cancer and other diseases to be diagnosed earlier and faster, we need to ‘lure’ patients into the doctor’s office when they feel healthy,” recommends Bivins. And it is difficult for the NHS because the system is under constant financial pressure. Doctors cannot spend more time with patients because time is money.
“Firstly, we should invest more in the NHS and secondly, we should change the culture around the NHS – to convince people to take responsibility for their health before they become seriously ill. You have to lead a healthy lifestyle and go to the doctor when you have a problem,” concludes Professor Robert Bivens.