The nhs and brexit: time for trade-offs | thearticle

What have the NHS and Brexit have in common? More than you might think. They are both immensely consequential ideas. They have marked the lives of every citizen of the United Kingdom. They

both have passionate supporters – and detractors. And they’re both failing. The NHS and (especially) a hard Brexit also have this in common: they are immune to common sense solutions.

Shrouded in myth, ideological fervour, faux patriotism and wishful thinking finding a practical remedy to what ails them is proving virtually impossible. Prime Minister Rishi Sunak is faced

with an in-tray heaped with hand grenades. The consequences of a hard Brexit and the desperate state of the NHS are among the most intractable and perilous. Refugees in the Channel, sinister

strikers and compulsory maths are a useful divergence. Pragmatic, evidence-based ideas are still-born under pressure from the Far Right and the populists (not necessarily the same thing).

Sound judgement is distorted by ideological virtue-signalling, like looking at yourself in a fairground mirror. So Sunak plays to the gallery: legislate to outlaw strikes, hang tough on

nurses’ pay, pretend that the biggest cost of living crisis in living memory is a passing phase. A man of soaring mediocrity, he reaches for nearest cliché: nurses, whom we were encouraged

to applaud on our porches in the heat of the pandemic, are now, suddenly, the enemy. The grotesque absurdity of this struck me last week. An operation, paid for by my health insurance, had

gone slightly wrong. I was treated within three days in a small, private, one-stop health centre. As the NHS buckles in the wake of the pandemic, private healthcare is booming. Meanwhile

patients are dying in the back of ambulances (literally) queueing outside overwhelmed A&E units, like stacked aircraft at a busy airport. Adrian Boyle, President of the Royal College of

Emergency Medicine estimates that the crisis is causing perhaps as many as 300-500 avoidable deaths a week. This is not hyperbole. This is dystopian Britain, one of the richest nations on

the planet, in 2023. You could describe the rise and fall of the NHS as a national embarrassment. But it’s far worse. It is a symptom of a country that has lost its way. It’s tragic and

desperately unfair especially on the less well-off. Something has to change. But talk of deep reform of the NHS (like fixing Brexit) is taboo. The debate is stuck between throwing more money

at it and hiving more bits to the private sector in the mistaken belief that it always does things better. The scandalous performance of (largely US) mental health companies, subcontracted

by the NHS with little oversight or accountability, should disabuse us of this fantasy. Private enterprises are in business to serve their shareholders, not perform a public service. The

totemic idea of a health service free at the point of need was the lynchpin of the new welfare state, a blinding flash of light and hope, after the darkness of World War II. It epitomised

the grit, compassion and patriotism of a country with a strong common purpose. But we were 50 million then. Today we are nearly 68 million. Life expectancy for men was 66 years, for women 70

years, in 1950. Today it’s nearly 80 years for men and 83 for women. In 1950, the NHS spent an estimated £460 million. This year it is likely to spend around £160 billion. In real terms,

NHS spending is 10 times higher than in 1950. This can’t go on. But it will. Talk of reforming this national treasure has become an ideologically turbo-charged political football. The same

is true of Brexit. You can argue that leaving the EU’s political institutions has merit because it claws back some democratic deficit. But leaving the single market, the UK’ s closest,

largest, most profitable market, after a decade of needless austerity, was an act of economic madness. It was Boris Johnson’s route to power and he sacrificed every last vestige of truth and

basic common sense on the altar of his ambition. Since Brexit capital investment is down. Gross fixed capital formation in healthcare is down. Real wages are below where they were 18 years

ago and have fared much worse than any of Britain’s peers. There has been a sharp brain drain, especially in health. Trade with the EU has fallen by 14%. The economy, according to the Office

for Budget responsibility, is worse off by £100 billion a year. Britain is poorer, more insular and more divided. Proponents of a hard Brexit advance two arguments in their defence: the

first is that Brexit isn’t working as well as it should because it’s not a “real” Brexit. This is the argument communist sympathisers used to explain away the failings of the Soviet economic

model. The USSR never managed to achieve escape velocity because “real” Marxism had been corrupted. The second is that leaving the EU was a democratic decision. To question the outcome is

heretical, anti-democratic and anti-British. This is a fatuous argument which fundamentally misrepresents the purpose of democracy. At its heart this messy and imperfect political system

offers the electorate an opportunity to change its mind if circumstances change. And yet both the Tories and Labour conspire in this _omerta _for fear of upsetting the so-called Red Wall

constituencies. The merest hint that we may need to tweak our trading arrangements with the EU, stirs the Faragists on the backbenches to mutiny, paralysing free thought. The challenges

faced by the NHS and the consequences of Brexit are, of course, not entirely analogous. But they have this in common: both are vital to the future health of Britain. Both need fixing. But

this can only happen if both issues are removed from the ideological bullring. Politics is the problem, not the solution — as the Truss/Kwarteng excursion into fantasy economics

demonstrated. The NHS is an extraordinary institution with a heart of gold. Repurposing it for the 21st century needs more than money. It needs an intellectual deep dive, not to ditch its

ethos, but find a way of making it affordable for the country and especially for those who need it most. As Wes Streeting, Labour’s Shadow Health Secretary says: “ The NHS is a service not a

shrine”. A non-partisan Royal Commission to look at the options, headed by a latter day William Beveridge (the man who midwifed the NHS and the welfare state), would be a good place to

start. The NHS is not, should not be, a partisan issue. It’s too important. Same goes for Brexit. It’s not a religion. It’s a political and economic issue to be managed. We can be sure that

it will not be preserved in aspic. Trade and international partnerships are, by definition, trade-offs. The Norwegians understand this. So do the Swiss. Trade-offs make the world go round. A

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