Skip to main content


The best way to fix the NHS

Ambulances queueing outside the Royal London Hospital. Vuk Valcic/SOPA Images/LightRocket/Getty

As everyone knows, says Melanie Phillips in The Times, “the definition of insanity is doing the same thing over and over again and expecting different results”. By that standard, Britain’s “unchallengeable attachment” to the NHS is “certifiable”. Waiting lists are at a record 6.6 million. There are a whopping 105,000 staff vacancies. Ambulance waiting times are so high that the NHS “no longer functions even as an emergency service”. For all our lionisation of the institution, other comparable countries get much better health outcomes. We’re in the middle of the pack of 19 OECD nations in terms of healthcare spending, but second bottom for life expectancy and deaths from treatable diseases, and last for survival rates from strokes and heart attacks.

“There is a better alternative.” Not the dreaded US-style private health system, but the “social insurance” favoured by the Europeans. It’s simple: everyone pays into a health insurance plan from a choice of insurers, with the government defining the minimum mandatory package and subsiding those who can’t afford them. Bureaucracy is kept to a minimum. Competition between providers “drives up standards”. And it works: among those comparable OECD nations, European countries make up seven of the top 10 for surviving treatable diseases. Changing systems would pose huge practical and political challenges. But with the “astronomical sums being poured into the NHS black hole”, the status quo is no longer an option.