Not the NHS - but the RTD

There's only one thing that people of any nation hate more than their fellow countrymen, and that's people from another country. To help them sustain the idea that they themselves are greater collectively than any other people, they need myths. In the UK, we have several myths - among them are the belief that we gave democracy to the world, that we have the best police force in the world and that our TV is the best in the world. But one of the most enduring is that our health service is the best in the world.

The NHS, we assure ourselves, is the gold standard that less-enlightened peoples wish they had thought of. The NHS is unassailable. While it is perfectly acceptable to complain about individual parts of the service, or to point out ways it could be better organised, daring to suggest that it is fundamentally flawed in any way is simply taboo. "Look at sick people dying in the USA" we say, while we wonder why they don't just do what we do. For the NHS is one of our greatest achievements, is it not?

Well, it's certainly better than what went before. Pre-war, rich people paid doctors and poor people went without, or if they were lucky, paid into some sort of health treatment cooperative. Mostly, you couldn't afford to be ill. Needless to say, lots of people were ill and died. But somehow, in the midst of the chaos of the Second World War, we managed as a nation to come up with the most radical rearrangements of how we delivered both education and medicine. The 1944 Education Act and the 1946 and 1947 National Health Service Acts were the crowning achievements of any government in the 20th century, for my money. I think it's no coincidence that they came about when attention was diverted elsewhere, but that's for another day.

These Acts brought about provision of education and medical treatment on a scale and breadth that was unparalleled in the UK. We look back on them today and think 'well, we may have slid into post-Empire turpitude, but at least we did something good'. Which is true, but it doesn't mean either brought about perfection. Let's think about it.

The NHS was the attempted nationalisation of the professional medical classes in the UK. But the truth is they were too powerful for the government. They used their influence to stave off the efforts of Bevan, who famously said he'd 'stuffed their mouths with silver' to make them play ball. Of course, he did no such thing - all he did was let them carry on what they'd always done but spend some time working for the government, treating the working classes with an inferior version of what their rich clients had always received.

This compromise continues to the present day. Why did it take decades for the hours that junior doctors to be reduced from around 120 a week, despite this situation making them so tired that they routinely killed people? - well, simply because it was essential to limit the numbers of junior doctors entering the profession, because that way the number of consultants didn't increase. And so the huge salaries were maintained, together with the status and perks.

For status is more important than money to the British professional classes. They crave adulation. Not only is it nice to be looked up to, it protects you. You cannot criticise me, because I am obviously superior to you. How dare you suggest that I make mistakes, or that I could avoid spreading infection by washing my hands or not wearing a grubby bow tie, or that using a simple checklist could reduce deaths and accidents in operations by a third? You are merely a tradesman and I am an expert.

Perhaps the best thing that Bevan did was to choose the name - the 'National Health Service' sounds great. The sweep of government, the elysian well-being, serving rather than ruling... and a 3-letter abbreviation which trips off the tongue, to boot. But the truth is it is none of the things the name proclaims - it's regional, not national. It's about treating illness and disease, it's not about promoting health. And it's not a service, it's a delivery system. It delivers treatments to ill people on a regional basis.

But I suppose Regional Treatment Delivery and the RTD was never going to catch on...