Why Corbyn is wrong about the ‘threat’ to the NHS from Trump and a US trade deal

There would likely be much less interest from America than is feared, as the system requires large reforms

When Air Force One flew out of the UK, it would not have been surprising if the sighs of relief at No 10 had been audible all the way to Trafalgar Square.

In less than 48 hours, Donald Trump had been less than polite to the French president, he had accused the Canadian prime minister of being “two-faced”, and he had arrived late for the Buckingham Palace reception. But he had also been successfully manoeuvred out of any public appearance a deux with Boris Johnson, he had managed not to say anything that could have been interpreted as interference in the general election, and – an almost miraculous bonus – he had called off his final news conference on the grounds that he had already held enough.

Trump had another present for the prime minister, too. Speaking before the opening of the Nato summit that was the reason for his visit, Trump categorically denied that the United States had designs on the British health service. The US would not want it, he said – in response to Labour’s charges that the Conservatives were putting the NHS up for sale – even if it were offered “on a silver platter”.

Now, of course, this is a Trump-ist generalisation, and detail is something else. The Labour leader, Jeremy Corbyn, has been brandishing leaked documents that show drug patents to be among the subjects broached by US and British negotiators in preliminary soundings about a post-Brexit trade deal. Whether an agreement on patents would necessarily lead to higher drug prices (as Labour claims) and whether it would really be so bad if US companies won contracts with an NHS that already spends 11 per cent of its day-to-day budget paying private providers are separate questions.

But Labour’s claim that the Tories aim to privatise the NHS, where it would be at risk from US predators, is based on a fundamental misunderstanding: that the US, or any US concern, would actually want it. The awe in which “our” NHS is widely held in the UK is not shared in the US. We might justifiably condemn their expensive, insurance-based system, which leaves almost 10 per cent of Americans uninsured at any one time (even after the introduction of Obamacare), and results in lower life-expectancy and higher infant mortality than in many European countries.

However, a widespread American view of the NHS is that it is an old-fashioned and inefficient monster, that it relies on rationing, and that its standards – of hygiene, privacy and much else – leave much to be desired. Why on earth would any US concern, least of all its big insurers, want to take on this behemoth, with its millions of staff and its ageing or PFI-indebted estate?

Oh, I know the standard argument – which is why Corbyn was knocking at an open door when he made the supposed US designs on “our” NHS a theme of his campaign. There are many, including doctors who insist with some passion that successive Tory governments have tried to force the NHS into a terminal crisis, by starving it of cash and staff.

At which point, they say, the private sector, whether from the UK, but probably from the US – because we all know the money-grubbing ways of US health companies – will be called in to “rescue” it. Then one fine day, we will all wake up to find ourselves in a US-style insurance situation, where the rich and those with good jobs have access to the best health services that money can buy, and the rest – well, the rest don’t.

That the NHS is not up for sale to the highest – and especially not to a US – bidder, does not mean, however, that the next government should just shovel more cash in its direction, as both main parties have promised to do. Scandals such as the recently exposed deaths and injuries in the maternity departments at the Shrewsbury and Telford Hospital Trust and the neglect exposed at the Mid Staffs Hospital Trust a decade ago may be exceptions, but satisfaction with the NHS overall has been declining, especially among younger age-groups.

One reason may be that fewer and fewer people remember the transformation brought about by the introduction of a health service free at the point of delivery; the gratitude felt by this generation is not automatically passed on, nor is it unconditional. An almost American-style compensation culture has been growing: the bill for medical mistakes is staggeringly high.

There may, though, I think, be another reason. Even as the commercial world has absorbed and adapted to modern ways, much of the NHS remains firmly stuck in the 1950s. Treatments and technology may have advanced, but the attitudes – egalitarian, often patronising, take-what-you-are-given-and-be-grateful, the communal over the individual – are out of step with a world of almost infinite choice.

Many European health systems – including the French, the German and the Dutch – reflect this new world generally better than the NHS, and it is to these systems, rather than to the US, that the next generation of ministers and NHS leaders needs to look. And, yes, this could mean shifting to an insurance-based system, but a European-style system of universal, but differentiated, coverage.

One of the first principles to go should be the strict division between private and public in the UK’s health system – which allows medical staff to work for both. This deprives the NHS of experienced consultants’ time – but confines patients to one or the other. Doctors may top up their NHS salary with private work, but you and I are not allowed to “top up” our hospital stay with a supplement for a private room or choice of food: it is either all private at stratospheric cost, or all public.

While keeping treatment the same, continental insurance systems allow for gradations – and thus bring more money into the system. Not being able to choose your class of hotel or rail ticket is unthinkable; but this element of choice remains anathema to the collectivist NHS: from appointments to shared wards, you take what you are given.

Training could be another area to look. Why, under EU free movement, did European staff flock to the UK? Because salaries, especially doctors’ salaries are higher here, and because some countries have a surplus of medics. But also because, for decades, the UK has stinted on training, leaving large numbers of jobs unfilled. It is beyond time to rectify this. Recruiting from abroad, especially from those countries where expensively trained medical staff are also in short supply, should be a last, and temporary, resort.

Why was it decided that all nurses (all UK-trained nurses, that is) should be graduates, adding a year or more to their course time? Why does it take so long to train a doctor? Might there not be accelerated courses for older entrants, who already have many of the life-skills young doctors have to be taught. The medical establishment would resist like mad, but a confident government and an NHS facing acute staff shortages could decide that needs must.

That Trump says he has no interest in the NHS may or may not lay some popular fears to rest – however unrealistic a prospect a US takeover always was. This should not mean, however, that the NHS is left to its own devices. European health services have a lot, including superior results, to recommend them. Post-Brexit, the NHS needs to swallow its pride and take a look.