Last month I was at an absolutely fantastic wedding where one of the readings – along with The Owl and the Pussycat – was The Beatles’ When I’m Sixty-Four. It was the first time I’d properly listened to the words, possibly because the chap reading it sounded so plaintive when he asked “Will you still need me, will you still feed me?” with particular stress on the “feed”.
At that point I hadn’t clocked the significance for the NHS (why would I?). But it came to mind again on Sunday when I turned my desk calendar (courtesy of RCN Scotland) over to July. There was a picture of the Fab Four and a quotation from the song, and a bit of cheery copy pointing out that the NHS celebrates its 64th birthday this year, on 5 July.
The Paul McCartney song has often been invoked by campaigners questioning whether older people get a good or a raw deal from various institutions, including the NHS. Parodies abound – including this recent version which questions whether free healthcare will survive the English NHS health reforms.
But now that the NHS is 64 – or will be tomorrow – should we be looking at how the lyrics apply to the health service itself? Are we still sending it a Valentine? Birthday greetings? Bottle of wine? (OK, maybe not the wine.) Or are we about to lock the door against it?
To take the Valentine question first, it’s actually quite hard to say. When you speak to people about the NHS, it’s almost fashionable to knock it (unless you’re talking to Americans in which case it’s nationally obligatory to say how marvellous it is). People will often say how awful the NHS is, and how so-and-so had a dreadfully long wait for an operation, although if you ask the same people about their own GP practice, or about their own local hospital, it’s generally a far more positive story. But enough of anecdote, what do the statistics indicate?
Last month the King’s Fund published data from the British Social Attitudes Survey, which has tracked public attitudes about key areas of public policy since 1983. The figures show that satisfaction with the NHS fell significantly from 70 per cent in 2010 to 58 per cent in 2011. This drop was all the more startling because it followed years of almost continuous annual improvements in public satisfaction since 2001.
In a blog on the King’s Fund website, chief economist John Appleby points out that the survey was taken at a time when there was a polarised and heated debate taking place on the Westminster government’s proposed health reforms. “Reports of opposition to the reforms were high profile,” he writes, “and, regardless of the merits of arguments on both sides, will have no doubt contributed, at a minimum, to a climate of uncertainty in the public’s minds about the NHS and its future.”
He adds that cost-cutting is probably adding to public discontent about the future of the NHS, not necessarily how it’s performing now – “which sees its expression in lower levels of satisfaction”.
The British Social Attitudes Survey, of a necessity, has an English bias in terms of population size – and, of course, the health reforms promoted by Andrew Lansley will not be implemented in Scotland (although whether they will affect health services north of the border is another question). So what are satisfaction levels like at a more local, Scottish level?
Patients in Scotland are increasingly being asked their opinions about health services and the results tend to be pretty good. For example, the 2011/12 Scottish Patient Experience Survey of GP and Local NHS Services (completed by 145,569 respondents) shows that at least 90 per cent of patients responded positively about their experience of consultation with doctors or nurses, although they were slightly less positive about access to GP services.
Lest we get too smug, however, and think the results show things are much better in Scotland, it should be remembered that English practices also score highly in patient experience surveys, again with around 90 per cent of those in England, Wales and Northern Ireland being positive about the care provided. Even more salutary are the findings from the Scottish Attitudes Survey, which in 2011 found that just 56 per cent (2 per cent below the British figure) were “very, or quite satisfied with the way the NHS runs nowadays”.
That’s still more than half – so, on balance, I reckon we are still sending the NHS a Valentine, although maybe a last-minute one bought from a garage, as we’re not quite as much in love with it as we were a couple of years ago. But what about the central question – now that the NHS is older (whether or not it’s losing its hair) do we still need it? Or should we be replacing it with a younger model – perhaps a model which makes more use of private providers?
I’m very certain in my own mind about the answer to this, but actually it’s probably fair to say that we don’t yet have the evidence to show which healthcare system is best. Yes, there are numerous UK and international reports which seek to compare health systems, but all have their flaws, not least because getting data which compares like with like is nigh on impossible, at least at the moment. And there’s the issue about what we actually value in a health service – broadly the UK system tends to perform well on measures such as universal access, but less well on survival rates from cancer.
There’s also the question about whether there is, in fact, a UK health service. I’m inclined to think there isn’t. Yes, all four countries have a broadly similar publicly funded service, generally free at the point of delivery, but they are diverging, and it’s getting to the point where comparing England with the rest of the UK is a bit like comparing biscuits and apples: they’re both foodstuffs, but that’s about it.
These growing differences should mean that objective judgement on how well each type of system performs ought to be easier to come by. Last week’s report from the National Audit Office comparing healthcare systems across the UK should be a good start – although, again, it was hampered by a lack of comparable data.
Then there’s the question of whether we’re still prepared to “feed” the NHS – that is, give it enough resource – as it turns 64. All UK governments say they’re protecting health spending, but that’s in relative terms; at a time when all public budgets are tightening, the ever-hungry health service certainly has no need to loosen its belt.
I really hope that we will answer the NHS in the affirmative, should it ask us The Beatles’ question. At the weekend I once again had reason to feel pleased that the health service is there, doing its bit to keep one of my loved ones on the road. Yes, it’s not perfect and – like most others its age, has its creaky bits – but I hope we recognise that we do need this particular 64-year-old. And I sincerely hope we continue to feed it, too.