Andrew Whitehead 
London Calling: How does India look from afar? Looming world power or dysfunctional democracy? And what’s happening in Britain, and the West, that India needs to know about and perhaps learn from? This fortnightly column helps forge the connections so essential in our globalising world.
For four days last week, tens of thousands of junior doctors set up well-mannered picket lines outside hospitals across England. They were on strike demanding more pay. Hospital nurses have already staged their own walk-outs with more planned for the end of this month. The most serious labour unrest in the history of the health service has delayed treatment for millions of patients.
Even if the strikes stop straight away, which they won’t, it could be months before hospitals are back to normal. Britain – a country so proud of its state-financed health service – is not a good place to fall ill just now.
In a nation not always noted for its commitment to equality, the National Health Service (NHS) enshrines a noble principle: healthcare free at the point of delivery and available to rich and poor, young and old, on an equal basis. I don’t pay to see my doctor; I wouldn’t have to pay if I was admitted to hospital; and given my age, I don’t need to pay for the medicines my doctor prescribes.
Illustration: Pariplab Chakraborty
But there’s a down side. If you go to the casualty ward at hospital, it may well be more than four hours before you are seen. It can take a week or two to get an appointment at a doctor’s surgery. And the waiting lists for specialist appointments or operations sometimes stretch for months or even years. More than seven million people – that’s one-in-ten of the population – are waiting patiently for NHS treatment.
The NHS is now so encumbered by shrunken budgets and time-worn buildings and organisational structures that trust in what was Britain’s most revered public institution is ebbing away. The rash of strikes is just one aspect of that gradual decay.
Established in 1948, the NHS is almost as old as independent India. That’s no coincidence. The defining aspect of Britain’s welfare state and the key step towards the unwinding of Empire were both the achievements of a Labour government (by far the most radical administration the country has ever seen) that swept to power at the close of the Second World War.
Over the decades, the NHS has become politically untouchable. Even Rishi Sunak’s Conservatives, the party of the free market, are committed to increasing funding for the state-run health service rather than dismantling what is unmistakably a socialist-inspired institution.
Of course, the NHS is not really free. It’s funded from taxation – at a cost of £200 billion a year (that’s $250 billion or Rs 20,000 crore), and this for a country with a population a little less than Tamil Nadu’s. And the cocktail of an ageing population and new and more expensive forms of treatment means the health service sucks up however much money is allocated to it and still cries out: not enough!
For an institution created at the end of Empire, the NHS bears an unfortunate echo of the imperial dispensation. For many years, Britain has failed to train sufficient doctors and nurses to meet its needs. So it imports them ready-qualified. Fully a third of NHS doctors and a quarter of nurses are not British nationals – Indians make up by far the biggest contingent of non-British medics in the health service (on top, of course, of the conspicuous contribution of Brits of Indian heritage).
The NHS couldn’t survive without foreign medical staff. But this reliance has the effect of draining skilled medical practitioners from countries which desperately need to improve health provision. Now Britain too is being hit by the swirls and eddies of the medical labour market. Thousands of newly-qualified British doctors are heading to Australia, where the pay is much better, the workload more manageable and the weather is a shade or three more soul-warming.
The labour protests which are rocking the NHS are a result of the squeeze in public sector pay. Ever since the global financial crisis 15 years ago, the public sector has been starved of cash and the pay of its workforce has, in real terms, declined. Allowing for inflation, many hospital doctors and nurses earn 20% less than a decade ago. The latest pay offer to medical staff is well under the current inflation rate of around 10%. And the patience of doctors and nurses has snapped.
Public opinion is strongly on the strikers’ side. Everyone has a story of how the skill, care and kindness of a hospital doctor or nurse had helped them, or a family member, through a time of anxiety and ill health. Sooner or later, Rishi Sunak will have to stump up more cash. But the money that goes on a wage increase can’t also be spent on the thorough-going modernisation the NHS needs.
Most Brits remain committed to the founding principles of the NHS, but neither politicians nor health practitioners have worked out how to make socialised medicine work in a rapidly changing world.
Andrew Whitehead is an honorary professor at the University of Nottingham in the UK and a former BBC India Correspondent.