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Friday, December 1, 2023
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An NHS doctor’s case for privatisation

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I AM an NHS junior doctor. Like the vast majority of my colleagues I voted for industrial action, now set for this month. Yet even if the government gives us everything we want, and pay is restored in real terms to 2008 levels, there are far graver problems with the NHS – the termites have dug deep into its very foundations, and my, how well they’ve dined.

I honestly believe it would be better to burn it to the ground and start from scratch than allow this bloated, decaying zombie to continue lumbering on. I’d be the first to pile up the kindling.

Imagine paying annual tuition fees of £9,000 for five or six years, before being thrown into a chaotic, failing system; often working nights, evenings, and weekends on-call. Where every decision you make could ultimately lead to a courtroom, facing a bereaved family and their legal team – all for around £14 an hour.

There is an exodus of doctors leaving for warmer, mostly Antipodean, climes, my own friends and colleagues among them. The government couldn’t care less if we go: they know there is an unlimited supply of doctors from India or Pakistan or West Africa willing to work in poorer conditions for less money than their British counterparts. This is the mentality that arises from prioritising short-term money-saving over the long-term wellbeing of your citizens. 

It’s not that they are worse doctors than those trained in the West, although some data suggests they may make more mistakes, rather it’s about inconsistency. Some of the best doctors I’ve encountered come from the Indian subcontinent, but so do some of the worst. When you hear that in certain provinces an individual can bribe their way through medical school, this is hardly a revelation.

By contrast, in the UK there is a pretty high threshold one must reach before taking final exams, and good luck trying to bribe your examiner. It is for this reason that British-educated doctors are so highly prized around the world. A British consultant can earn more than £500,000 a year in Saudi Arabia, tax free. Leaving aside the ethical misgivings, the point is they are not offering such lucrative contracts to, say, Bangladeshi doctors.

One of the commonest accusations levelled against the Conservative government is that they’re trying to dismantle the NHS . . . if only that were true. I didn’t realise it was possible for an organisation to be so inefficient until I started working in it. More money is the last thing it needs. Indeed, you could divert the entire national budget to the NHS and it would still swallow it up and ask for more. At present it is being held together by rubber bands and Blu Tack, along with the remarkable goodwill of its long-suffering doctors.

I’ve been working as a junior doctor for three years, and I can tell you the sheer scale of waste and redundancy is indescribable. It’s almost as if they’re trying to waste as much money as possible. The problem is they’re the only game in town, and they know it. No competition means no incentive to improve efficiency. From what I’ve heard, procurement staff accept whatever price the pharmaceutical companies demand; after all, it’s not their money. Middle/upper managers (often with Labour ties) on six-figure salaries are rife. They push bureaucratic documents to one another and strangle the organisation in red tape, but certainly have nothing to do with improving patient care.

There is also the fact that it isn’t a national health service at all, but an international one. People come from all over the world to take advantage of our generosity, laughing all the way home. But as much as health tourism is an issue, and a bigger one than the higher-ups like to admit, it pales in comparison with rising population as a whole. One of my (black, as it happens) colleagues working in an obstetric ward in East London told me that, in her entire four-month placement, she saw but one baby delivered to an English-born mother, and she was ethnically Somali. In a med school lecture on service provision, I once asked whether the scale of immigration might have a role in increasing demand and therefore waiting times and budget pressures. The lecturer looked at me as if I had proposed resurrecting the Third Reich, and told me it was a totally inappropriate question that I shouldn’t even be asking.

Woke ideology grows and metastases daily. Last year alone NHS management spent the better part of £46million on diversity and inclusion officers. Indeed, staff must now attend mandatory classes teaching us how all of the world’s woes can be laid at the feet of the straight, white, male Untermenschen.

Further, the NHS spent just shy of £66million last year on translation services for the legions of non-English speakers accessing our healthcare system. If I became ill in Italy or Thailand or most of planet Earth, I (or my  insurers) would be expected to pay for translators, but here everything is provided for you. Translators charge by the hour, and I have seen them conduct a five-minute conversation and leave . . . that will be £50, please.

But the main, apparently insurmountable, problem is that the NHS has become a political sacred cow, impossible to criticise without being decried as a blasphemer. The mistake (often deliberately) made is to confuse the NHS with the people who work for it. The latter are often dedicated, compassionate and hard-working, the former is an obscene monstrosity.

Whenever one discusses even partial privatisation, people invariably point to the States, ignoring Australia, New Zealand, Spain, Japan, etc, where large elements of the private sector are integrated into the system. Take Canada: a competitive insurance market means that premiums are relatively cheap, and more than two-thirds of the population have private coverage. There is an excellent healthcare safety net for those without insurance.

In Britain however, the system is the safety net, which is why it is creaking at the seams. Fewer than 10 per cent of people have private coverage, and little competition between insurance companies means sky-high premiums which only the wealthy can afford, exacerbating a negative cycle of unaffordability. There is a weird stigma against private healthcare in this country, but think of it this way: would you pay £50 to see your GP the same day? Would you pay £500 to have your knee surgery next month rather than next year? I suspect for many people the answer is ‘Where do I sign?’ If integrating the private sector into the public one does that, as proven to be the case in other developed nations, so be it.

I did a stint in Australia, where the doctors used to laugh at the NHS, saying it was like a cult. No other clinicians in the Western world would put up with such poor working conditions for such poor pay, they said, and it’s only the goodwill of the indoctrinated cult members, along with an endless supply of public funds, keeping it afloat. Their own hospitals are full of expats who have broken free from the commune, many saying they had no idea how bad it was until they got out. The more I’ve experienced of it, the more I have to agree with them.

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