NHS worship is over

This article was first published in The Critic.

Britain has perfected a peculiar kind of doublethink that has held up the national conversation about the state of the NHS for decades. Publicly, we extol its virtues as the closest thing to our national religion, parade it at the opening ceremony of the Olympics, and treat as foul and seditious any criticisms of the fitness of its model. Yet in quiet moments of candour, the British public have held opinions that the political class have been too timid to vocalise. A new report from the Prosperity Institute, which draws opinions from 5,000 adults, suggests that people are no longer willing to keep their true feelings private.

The headline finding is bracing in its honesty. 49% of the British public believe that immigration is a net burden on the NHS — more than double those who think it is a net benefit (22%). This is not a view held in the margins, nor confined to a caricatured corner of the electorate. It cuts through the political landscape like a geological fault, dominating with Reform (74%) and Conservative votes (56%), and even animating huge swathes of Plaid Cymru (50%) and SNP voters (44%) who are not traditionally associated with immigration scepticism. With 51% of respondents expressing disapproval of the way the government is handling immigration, the public has not just reached its conclusion, but is losing patience with politicians who don’t agree.

The public have got to this point through their own wearying, even harrowing experiences About 60% of respondents in Prosperity’s new report had used the NHS in the last 6 months. 30% had experienced delays when urgent care was needed, 29% had witnessed a family member endure a similar fate. Behind these numbers are the soul-sucking elevator music people have to bear with when put on hold whilst being twentieth in the queue at 8:01am for a GP appointment, and the pain of what seems like endless hours as they wait to be attended.

So, what we see here is not some burst of innate xenophobia which Brits can no longer contain. It is an expression of frustration due to a blatant disregard of people’s experiences by politicians who offer banal platitudes as responses instead of active reform. People are not ignorant of the fact that immigrants work in the NHS – nearly 1 in 5 healthcare professionals is foreign born (double what it was at the start of 2010s). But crucially Brits now reject the notion that somehow, having more immigrants working in the NHS is an indefinite panacea that heals the strains on a system upon which they depend.

“Brits now reject the notion that somehow, having more immigrants working in the NHS is an indefinite panacea that heals the strains on a system upon which they depend“

One of the major reasons many policymakers say immigration should be restricted is because of the added strains it causes the NHS: yet they still advocate for more immigration as the solution to providing sufficient NHS staff to sustain the same system they say is overstretched. This creates a tension in policymaking: immigration is considered both as a cause of the pressures on the NHS as well as the solution to the shortfall in NHS staff numbers. The lack of British NHS staff reflects a long-term lack of funding for training new staff. As a result, recruiting overseas staff has shifted from being a temporary reprieve to being structurally embedded within NHS recruitment strategy. 

The public think this should change. When asked whether British doctors and nurses should be given priority in the hiring process, there was a unanimous approval across the political spectrum, with 65% agreeing across the board. Similar concerns surface in perceptions about the care people receive. 42% of respondents (including 47% of Labour and 46% of Conservative voters) believe that the standard of care foreign NHS staff provide is lower than that provided by British NHS staff. When a belief such as this takes hold, dismissing it as “ignorance” would be an abdication of duty.

The public have not concluded that the solution is an American-style healthcare. Across the political divide (including Reform voters), the US-model had a net-negative favourability of -22%. Instead, people still believe in preserving a form of universal healthcare while opening healthcare up for choice, competition, and mixed provision. Switzerland, Netherlands and Germany — countries which provide a mixed-model approach to healthcare delivery — were the most favourable. If we could achieve this, the NHS would no longer be treated as a failing religion that must be preserved, but simply a valued service that functions efficiently. Strangely, it is the NHS’s very fragility that has made it so impossible to discuss its reform.

There is no compassion in a system whose solution to labour rigidities is “import more labour” whilst providing services to recent arrivals at the expense of British citizens. That is complacency. The public have seen that the immigration’s promise to resolve the strains in the NHS is not working. They are tired of being told that their observations are bigoted. The question is: when will people at SW1 catch-up?