JONATHAN MILLER: The hopeless NHS is temple to a dead religion. But there is a FAR better way – and I live in the country that’s nailed it… _ Hieuuk
Lord Darzi has wasted his time. We didn’t need his new report to learn that the NHS – grotesquely touted as the ‘envy of the world’ – is a disgrace.
Every so-called reform, from one government after another, has made zero difference. Taxpayers’ money just pours into a dysfunctional system, while the experience of patients gets worse.
Like a malignant cancer, the bureaucracy metastasises, more interested in protecting itself than in looking after the sick. While there are many dedicated nurses and doctors, the top-down system – the same as you’d expect in Soviet Russia or Castroist Cuba – has manifestly failed.
Access to healthcare in France is via the indispensable Carte Vitale identity card
But it doesn’t have to be this way. Just 20 miles across the Channel, there’s a healthcare system that works. The newspapers in my adopted country of France are free from daily horror stories of 72-hour waits in A&E or months spent languishing for cancer treatment.
Elderly men are not asked if they’re pregnant. There are no ‘crumbling buildings, mental health patients accommodated in Victorian-era cells infested with vermin with 17 men sharing two showers’, in Darzi’s horrified words. The system is efficient and effective.
If Keir Starmer wants to deliver on his weirdly funereal speech yesterday and perform the ‘major surgery’ he rightly says is necessary to heal the ailing NHS, he doesn’t have to look far.
I speak from experience. I’m 73 and, like many ‘boomers’, I’m increasingly needing medical care after years of rude good health. None of my problems are life-threatening, thankfully, although some are serious.
And here’s the thing. After repeatedly using the French healthcare system, I have only fulsome praise. When I phone my GP (généraliste) a human being answers instantly and books me in.
If my needs are urgent, I know I will always get an appointment that day. If I need a blood test, I just stroll into the local, privately-owned medical laboratory to be seen in 10 minutes, getting my results within a couple of hours.
When my wife broke a bone in her foot recently, I drove her to our nearest emergency room in rural Occitanie. She was seen within five minutes, had an X-ray 20 minutes later – and was discharged within an hour.
When I woke up struck by a nasty and painful inflammatory disease earlier this year, my GP saw me the same morning. She referred me to a brilliant specialist at the hospital in Béziers, who saw me the following day.
He ordered a biopsy, performed two days after that.
The aftercare was fabulous. For the next 10 days, a district nurse visited me at home every day to change the dressings. You must be thinking: surely, for all this, we must have some extortionate private health insurance?
At our age, it must cost us thousands in premiums, rising every year. All well and good for you, Miller, but not practical for most Brits.
Wrong. France, like Britain, has a universal healthcare system – in which the entire population is covered. There is nothing unusual about my experience. The World Health Organisation has consistently ranked France as having the best healthcare in the world – and it’s easy to see why.
Everyone legally resident here, regardless of income, is covered by statutory health insurance –known as the Sécu, short for Sécurité Sociale.
This is funded by: employers (who pay a charge for everyone they hire, rather like employer national insurance in the UK); employees (who pay a portion of their salaries towards it); and the self-employed (who surrender a slice of their earnings for it).
Crudely speaking, these groups cover the unemployed and – in limited form – illegal migrants. The Sécu pays not only for France’s world-leading healthcare system but also its generous state pension, family benefits and unemployment insurance.
Access to healthcare is via the indispensable Carte Vitale identity card. Pharmacies, hospitals, medical laboratories – everything is authorised by the card.
Choice is fundamental in the French system, with public and private hospitals competing, but both funded by the Sécu and charging the same fees.
The competition means that the patient is in charge. Not an unaccountable monopoly provider that can get away with treating its customers with indifference bordering on contempt.
There are small up-front payments – which help to cut waste. To see my GP costs me £6.30 – half the price of a pizza.
My own recent surgery cost me a ‘co-payment’ of £41 – far less than the £200 it cost to take my dog to the vet last time. My prescriptions cost me £1.50 to £6.00. But even these small fees are waived for anyone with chronic illnesses.
Sir Keir Starmer speaks after the publication of Lord Darzi’s independent investigation into the state of the NHS in London yesterday
There are small up-front payments, which help to cut waste. To see my GP costs £6.30, half the price of a pizza
Furthermore, about 95 per cent of French people spend a further £34 a month on private health insurance, known as mutuelle, which covers the co-payments and anything else not fully reimbursed by the Sécu. Pay the mutuelle and you need never pay anything again.
Back in Britain, it may feel like the NHS is free – but deep down, of course, it’s not.
The Government spent £212billion on healthcare in 2022-2023 – more than 18 per cent of its total expenditure. (The figure was just 13 per cent in 1996-1997 and only nine per cent in 1978-1979.) So almost a fifth of your taxes are being lavished on the bloated service. Do you feel like you’re getting your money’s worth?
True, France spends about £4,400 per person on healthcare, higher than the UK’s per capita spending at £3,500. But, crucially, almost all of that money is spent on care, not managers.
A British friend who gave birth to her first child in England and the second in France told me it was like being upgraded from economy to business class.
France is not some lone paradise. Its model, with variations, pertains across much of Europe. The Netherlands and Germany also use the ‘social health insurance’ model – and all perform better than Britain on every key indicator from death rates from avoidable causes to life expectancy at birth and infant and maternal mortality rates.
Lefties in Britain invariably point to the United States as the lone alternative to the sacred NHS. America is the only developed country without a universal healthcare system – and Americans go bankrupt every day for want of insurance. It bears no relation to the European model.
Keir Starmer has promised the ‘greatest reimagining of the NHS since its birth’.
I hope he delivers. But unless his government moves to something resembling the French system, I guarantee that, like every previous attempt, his reforms will end in failure. The centralised, nationalised, hopeless NHS is a temple to a dead religion.
I have family members my age back in Britain. As I grow older, I am grateful every day that I am not in their place.
Jonathan Miller is the author of France: A Nation on the Verge of a Nervous Breakdown.