By Nick Seddon, Deputy Director of Reform
The Flat Earth Society took a bit of a hit
when satellite images taken from outer space showed the earth as a sphere
rather than flat, but they weren’t fazed. The Englishman Samuel Shenton, who ran
the modern organisation in 1956, remarked: "It's easy to see how a
photograph like that could fool the untrained eye." There’s nothing new to
the belief that the earth is flat, of course. Indeed, it was almost universally
held until as late as 4BC. Then the likes of Aristotle started to provide
evidence of a spherical earth, and by the Renaissance it was widespread
knowledge throughout Europe that the Earth was a sphere, especially thanks to
the likes of Galileo. The best headlines of the cult Flat Earth News during the '70s and early '80s included
"Galileo Was a Liar" and “World IS Flat, and That's That".
Sadly, although there are some websites for this seriously retro club, the
society seems to have been disbanded in the early years of this century. It’s
probably around this time that some of its members started to join the top
ranks of the British Medical Association.
If
you want to laugh, you should turn on your computer, turn up the volume, make a
cup of tea and watch this animated cartoon, Look After Our NHS. That’s right, the
venerable British Medical Association, once one of the most vehement opponents
of the NHS – they called Bevan a “medical Fuehrer” and said that nationalising
hospitals represented “the greatest seizure of property since Henry VIII
confiscated the monasteries” – is launching one of
the most comical campaigns ever. Viscerally and ideologically against markets,
they argue that the NHS’s financial challenges will be overcome by “abandoning
this market in healthcare”. Let’s not worry too much about the fact that there
isn’t a market in healthcare – it’s the policy direction, but implementation
through central diktat rather than real competition has short circuited the
system. Let’s not worry too much about whose NHS it is either – it’s for the
patients to decide who looks after them, and they don’t seem to mind whether
they’re treated privately or publicly so long as it’s high quality and
dignified.
No, let’s just take a moment to think about
markets. We’ve become used to lifestyles and possessions that a previous
generation couldn’t have conceived of and ordinary people have become
accustomed to choice, variety and responsiveness to their demands. Just think
about how markets, aligned with scientific and technology, have changed our
world for the better. In the 1980s, cars used to break down. People used to
moan about it all the time. And British Leyland did nothing about it. And then
along came some healthy international competition from the Far East, with some
six sigma advances. When did your car last break down? Indeed, think about any
sector you care to that has undergone a revolution. Think about telephony – do
you remember how expensive it used to be to make international calls? – before
fibre optic cables. Think about food production and distribution.
Or take information technology. Computers
keep on getting smaller, faster, more powerful – and cheaper. Remember the old
mainframes or the first Amstrads? These companies weren’t the ones who reformed
themselves, it was the disruptive competition and inn ovation of Intel, Sun,
Microsoft and Dell, creating extraordinary value. In turn, none of these
organisations was able to do what Google did, or MySpace, Facebook and other
advances in open source technology which have revolutionised the way that
humans interact on the planet. Drugs companies are developing new types of
cancer weaponry such as monoclonal antibodies which, like mini guided missiles
target the tumour itself rather than the surrounding tissue, in the way that
the carpet bombing of chemotherapy wipe out the body’s entire immune system.
Technological advances across the world are changing the way healthcare
professionals work – and in the best countries the healthcare professionals are
leading the change. Sure, markets have risks but minimising those risks is why
we have regulation.
But here we are in Britain with the NHS. There
are some sensational pockets, with the very best of healthcare and financial
governance. Our clinicians are among the very best in the world. Overall,
though, the outcomes don’t do well against the likes of Switzerland or Korea. All
countries are struggling with the three horsemen of ageing demography, rising
costs and rising expectations, but the best are developing competitive
healthcare systems that continue to provide universal coverage. The NHS isn’t
the envy of the world, and hasn’t been for a very long time, and it isn’t –
after all the spending – the envy of the world’s finance ministers either. NHS
spending accounts for some £110bn of public spending (9 percent of GDP), but comparing
projected spending and likely demand, there’s likely to be a major shortfall –
NHS Chief Executive David Nicholson has said that the NHS must look to save £20
billion by 2014 – which means that the need to fight the fat could hardly be
greater.
While over the past decade, according to the
Office of National Statistics, NHS productivity has fallen by almost 4%,
productivity in the market sector rose by nearly 23% in the same period. We
need more, not less, choice and competition to drive up quality – clinical
outcomes and patient experience – and drive down cost. Markets are the best way
yet found to get people to do things that they don’t want to do – such as upping
their game – and the most effective means yet found for distributing more
resources. A commitment to the health of the nation, to national health, is not
the same as a commitment to the NHS, or every country would have an NHS, which
they don’t. Change is hard, and it’s hardest on those who find it hard to
change, but change is also important, and it brings opportunities as well as
pain. Will we stay stuck in the past or find a way to create the future?
The world is not flat, and that is that.
