From Free Life, Issue 30, May 1999
ISSN: 0260 5112

This latest offering from the Health and Welfare Unit of the Institute of Economic Affairs is a welcome change from the nonsense lately pouring out of Conservative Central Office.

According to Professor John Spiers, the National Health Service is the last failed nationalised industry.  Despite superficial changes in recent years, it continues to express the collectivist assumptions of the 1940s.  By removing the price mechanism and replacing it with subsidy and rationing, and by stifling competition, it has created scarcity where none need really exist.

The problems that result from this - delays in treatment, decisions whether to treat at all, and a general disregard for the wishes of patients - are endemic to the NHS.  They cannot be solved by any likely increase in funding.

Professor Spiers takes a hard, unsentimental look at the realities of this nationalised semi-monopoly.  What he sees does not reflect the gushing tributes heaped on the NHS by every politician.

There are shortages of nurses and other skilled staff. [p.42]

Expensive drug treatment for conditions like multiple sclerosis, Alzheimer's disease, and prostate cancer are often denied to patients who could benefit from its use.  For example, only 15 per cent of those who would benefit from interferon beta, which can slow the progress of multiple sclerosis, are receiving it. [pp.47-48]

Many patients suffering from chronic kidney failure are unable to get the treatment they need, and may die as a result.  Among European nations, "only Bulgaria treats fewer patients per head of population per year".  In the United States, by contrast, every person who suffers kidney failure is entitled by law to dialysis and transplant services, if necessary. [pp.49-50]

There is a shortage of cancer specialists, as a result of which survival rates for cancer patients in this country are among the lowest in the developed world. [pp.39-40]

Professor Spiers believes that radical reform is needed.  The physical assets of the NHS should be given back to local communities as not-for-profit local charitable trusts; and individual patients empowered to buy treatment from their healthcare provider of choice.

The book does not recommend the full libertarian solution, of a privatised and deregulated system of healthcare - one where individuals can buy any treatment they please, no matter what the qualifications of their advisers, or can buy and use the medications of their choice.  Even so, it is a quiet and persuasive exploration of what is wrong with the present system; and it presses the need for a solution that goes beyond Haguish sound bites and another few billion of the taxpayers' money.

For this, both Professor Spiers and the IHA Health and Welfare Unit are to be congratulated.

Iti Saflaia