Britain’s health care system has been broken for quite some time, but it’s not beyond repair.

While US president Donald Trump was incorrect about why people were marching about the National Health Service (they were protesting the level of government spending), there was some truth in what he said about “health care going broke and not working.” But judging by many Brits’ responses to Trump’s comments, which were not taken well, you might think the UK’s free health care system is perfect. It really isn’t.

Like many other nations, Britons see America’s health care system as the antithesis of good care. In comparison to the cost and complication of the US system, the UK’s national health service looks dreamy: No matter who you are, where you’re from, or what your profession, you simply get the care you need—for free.

Consequently, Brits adore the NHS and hold it up as a sacred idol. We offered it tribute in the opening ceremony of the 2012 London Olympics and meet criticism with red-eyed, frothy mouthed anger. But the truth is that the NHS is not great—it’s nowhere near close to the best in the world. And without addressing real problem within the NHS, we’re only pushing the system into further disrepair.

The NHS is not that great

Those who argue that the NHS provides the best care and service in the world often cite extremely limited comparative studies and rankings. However, look at more comprehensive reports and you’ll see that the UK falls behind in terms of survival rates. According to think tank UK2020, “If [the UK] had the survival rates of those countries with the best health outcomes, over 46,400 lives a year would be saved.” You can see the full breakdown of the stats per illness and which country is the best here.

Services provided to patients are underwhelming too. The UK only has 2.7 hospital beds per 1000 people, less than Germany (8.2), France (6.2) and the entire EU average (5.2). It also has one of the lowest number of practicing doctors per population in the EU.

It’s easy to blame the government (especially the Conservative party, where the narrative is that the Tories are always trying to “sell off” the NHS) for not throwing more money at Britain’s free health care, but the truth is, spending is continuing to rise.

While people are always keen on pointing out, especially in the light of Trump’s criticism, that the UK spends dramatically less per capita than the US on health care, the US doesn’t have a free health care system, so the comparison is moot.

However, there many issues that are in the hands of health care workers themselves. The system is bloated and wasteful, hindering care and leading to unnecessary deaths. Over £10 billion ($13.9 billion) has been wasted on a failed attempt to update the NHS’s patient record systems. Over £1 billion has been lost to fraud. Patients waste nearly the same amount annually in missed appointments. Imagine where that money could go if we truly tackled these problems.

A case study in failure

The biggest issue is that when the NHS fails in care, it leads to misery, permanent problems, and avoidable early deaths. Yet the fallout over Trump’s comments reveals how far Brits will go to defend their health service. Almost every day, I hear the same narrative: A traumatic health event, followed by mediocre care, and then a declaration of gratitude for the NHS, regardless of the outcome. If you do speak out, you have to do it anonymously, for fear of uproar.

This anonymous doctor’s account of the system failing his father is one I’ve heard echoed among my own family and friends. My own father was a case study in the failure of our system: Healthy his whole life, and only “a bit on the round side,” as he would say, he was rarely ill. One day he blacked out and had a fit. The hospital we rushed him to refused to give him a scan, saying he was “just stressed.”

We begged. We pleaded. They wouldn’t budge, dismissing our concern as paranoia. A year later, during a routine eye test for new glasses, opticians spotted something on my father’s optic nerve. It was only because that optician (who we paid for privately) finally recommended it directly to the doctors at the hospital, that my father got a scan.

Turns my father had a brain tumor that had grown rapidly over the year. Doctors likely would have detected it during a scan during that first episode at the hospital.

The next year was a Kafkaesque nightmare of trying to get treatment. The NHS informed our family that my father was likely to die within nine months to a year, and that the only hope we had was aggressive radiotherapy—but we’d have to wait at least nine months to get him on the list.

After draining some savings to privately pay for radiotherapy, we got one round of treatment that seemed to make a bit of a difference. But after that, we had to continue with free health care, because private health care without insurance was sapping our life savings. The NHS treatment was a degradation in care and service, including the same nightmare scenarios detailed by that anonymous doctor. On one occasion, as my father was having a seizure, a hospital nurse observed, “oh look, your dad is falling asleep.” My brother and I had to jump in and do the nurse’s job. Another time, he was in a ward and needed to go to the bathroom, but the nurses ignored him. He then got up and fell very badly, hitting his head against the floor and getting a severe hematoma, which was probably the worst thing that could happen to someone with a brain tumor. The list of incidents like this all contributed to his untimely death, which haunts me to this day.

So, you can imagine how I felt when my mother recently suffered a prolonged seizure in the middle of a restaurant. The NHS ambulance refused to take her to the hospital for a scan—even though we were next door to one of the biggest hospitals in London.

But that wasn’t the end of it.

I once threw out my back so badly, I was crippled on the floor at home. I called the NHS non-emergency services and they said they would not send an ambulance, but would consider sending a doctor. Over 12 hours later, the doctor arrived as I was falling into shock due to the pain—and he immediately called an ambulance.

On arrival at the hospital, the nightmare started again. Nurses refused to give me painkillers stronger than ibuprofen, and said I was wasting their time and being impatient. I was there for hours without seeing a doctor. I asked my husband to knock me out so I wouldn’t have to deal with the pain (he didn’t, by the way). By the time the doctor came, he looked aghast and asked the nurses why I wasn’t given any painkillers as I was close to going into shock again. They then gave me some form of painkiller, but one that barely made a difference. They then accused me of “not wanting it to work.” It was painful and humiliating.

After long hours waiting, I finally received an x-ray and was dumped in a dark and cold ward. Unattended and unable to go to the toilet, there was nothing to do but wait, surrounded by people wailing and soiling themselves. This was not the “best in the world” health care that people are led to believe by various studies and ranking systems.

***

I’d like to say that things are changing for the NHS and care has improved since all these incidents—but they haven’t. In fact, all that’s happened over the years is that there is a “culture of cover up” of preventable deaths due to mistakes and lack of care.

Several friends who broke their feet and their ankles in sports have been refused scans at the hospital, resulting in permanent pain or fused bones that led to more visits and more treatment than would’ve been necessary if the problem was fixed in the first place. A friend who couldn’t breathe properly for years was told she had asthma instead of being tested—it eventually turned out that a rogue artery was crushing her windpipe. Others have been told that they wouldn’t be given certain types of medicine, because they are too expensive. Brits spend years in private care, and money, to fix the messes that the NHS has made.

We have become a nation willing to accept poor care and errors that result in death, for the sake of holding onto a 1948 ideal that is struggling to cope with modern day needs. We are a nation of reaction, not prevention. Through the NHS, we plough our time and money into palliative care instead of investing in the right treatment at the right time.

It’s easy to blame it all the NHS’s ills on money. But lapses in care and service go beyond this.

There needs to be a responsibility and accountability for bad service.Sorry notes won’t bring back your loved one or undo the progression of an illness or stop the pain. Even a lawsuit won’t bring back your grandparent from dying because of malnutrition in your hospital or contracting and dying from a superbug because orderlies haven’t done the basic task of keeping the place clean.

And if the solution, one might argue, is more money for the NHS, then where will it come from? Tax increases are always unpopular, even if they would go to fund free health care for all (something that I would always want for any country in the world). Economists like Steven D. Levitt, who wrote Think Like a Freak which followed the popular book Freakonomics, explain how, when a service is deemed “free,” there is more likely to be waste by those use it and those who administer it.

Levitt proposed an alternative to how the NHS can remain “free” but adopt more rationality and accountability in spending on both the system and patients. Experts have nominated similar ideas that could help abate the waste, like a missed appointments fee of £10 a visit, while some float the need to welcome private money into the system.

Meanwhile, others have argued that changing the ethos of the NHS might lead to greater savings and less waste, thereby improving service and care. Former UK health secretary Alan Milburn pointed out that shifting “emphasis from diagnosing and treating illness to predicting and preventing ill health” would make a huge difference. Others like Shirley Cramer, chief executive of the Royal Society for Public Health, say the same: “Public health and prevention are the key to the survival of the NHS. Investing in population health and preventing disease is highly cost-effective–by reducing future demand on NHS services, preventive measures have the potential to save the NHS billions of pounds.” Even Lord Nigel Crisp, former chief executive of the NHS, agrees.

These are all tangible fixes, and make sense. But, until we stop pretending that the health care system is perfect and blame inadequate government spending for every issue the NHS has, we are destined to be cared for by the hollow shell of a rapidly failing utopian ideal.

Source: Quartz