Your last paragraph caught my interest. Can you point me at countries that are widely accepted to have done a better job?
My own experience of the NHS (as a non-Brit who lived in the UK for more than a decade) is that it is inefficient at the small things (sitting in a waiting room for an hour - but being shamed if I show up 10 minutes late for my appointment) but brutally effective at big important things (treatment for life threatening diseases - worked well, but the biscuits were rubbish). I know this isn't data, but I also know that British people love to carp about the NHS, and having lived with health services in two other industrialised countries, I quite liked it.
The problem with British people's opinions of the NHS is that they routinely conflate the NHS with healthcare. (BTW, I am British myself). You're doing the same thing here.
The NHS is not healthcare. The NHS is not doctors or nurses or life saving operations. The NHS is not hospitals. All first world countries have these things, but none have an NHS except Britain.
The NHS is a bureaucracy that manages resource allocation. That's it. That's all it boils down to.
When you saw life saving operations working as hoped, that isn't happening because of the NHS. You'd see the same in France, Germany, Sweden, the USA, Japan or many other places. We don't judge the skill of a bureaucracy or institution based on the skill of individual employees, we judge it based on factors like:
1. How much overhead does it impose?
2. How competent is it at organising its operations?
3. How agile is it, how able is it to react to new circumstances and continually improve itself?
4. How many people can access its services, who might want to use them?
5. If it fails at any of those criteria, how easy is it to switch to a competitor?
The NHS varies from average to poor when evaluated by these criteria, with the exception of (4) where it gets the best possible score because it even happily treats people who flew in to the UK specifically for free treatment! But if we exclude that edge case then it becomes pretty average again, because universal access is solved in other societies using insurance schemes of various kinds (sometimes mandatory and subsidised). The exception is the USA where for cultural reasons a lot of people don't like being forced to buy health insurance.
Although its overhead is reasonable when evaluated in pure GDP terms, this is achieved partly through building up large maintenance backlogs which is hardly sustainable: true cost of the NHS to the UK should probably be higher than is actually reported. The government has tried several times to force the NHS to spend money on maintenance and upgrades but usually fails: the NHS takes whatever money was granted to it for this purpose and immediately spends it on daily operations in violation of their agreements. Nothing happens because to Brits the NHS is a holy religion, so NHS management don't really feel accountable.
The biggest problem with government run industries is not that they can't carry out their mission at all. Soviet factories successfully made steel and rockets, after all. Their problem is lack of agility and lack of quality. Agility: see the NHS testing ramp-up problems discussed in sibling threads. Quality: see how slowly the NHS ramped treatment back up after the April shutdown. Other countries did much better in that regard, because private hospitals desperately want to treat people in ways that the NHS just doesn't. How could it be otherwise: if private hospitals don't treat people then they run out of money and go bust, like any other business. If the NHS doesn't treat people, its staff basically get a paid holiday with no negative consequences. Of course that affects people's behaviour.
I said average to poor, that's true except for (5) where the impact is catastrophic. Its tax funded status means the private health sector is seriously throttled in the UK. So only the rich can work around NHS failures, and even then not always (private hospitals don't do the full range of treatments in the UK).
The principle of "free at the point of use" is the critical factor in the NHS; while other countries manage to achieve that with different organisational structures. (4) is critical. Any whiff of ineligibility by payment is completely unacceptable, and rightly so, or we'd end up with the US disaster. From a political point of view, we have to defend the existing system because otherwise the US one will be forced on us. Nobody in UK politics will give us the Swiss system.
> tax funded status means the private health sector is seriously throttled in the UK
This doesn't make sense? Bupa exists?
Private health insurance is quite cheap in the UK compared to America because anything complicated or expensive can and will be dumped back on the public sector.
> this is achieved partly through building up large maintenance backlogs which is hardly sustainable: true cost of the NHS to the UK should probably be higher than is actually reported. The government has tried several times to force the NHS to spend money on maintenance and upgrades but usually fails: the NHS takes whatever money was granted to it for this purpose and immediately spends it on daily operations in violation of their agreements. Nothing happens because to Brits the NHS is a holy religion, so NHS management don't really feel accountable.
Nobody in UK politics will give us the Swiss system
How do you know? Nobody talks about alternatives to the NHS in the UK, even though it's an obvious topic that should be talked about all the time (the UK's a highly visible exception to the consensus of other rich countries and that would normally provoke debate). You don't actually know what the alternatives to the NHS are because any attempt to be honest about the system's problems are immediately met with a horde of leftists yelling things like "Tory propaganda", and insisting that anyone who criticises the NHS inexplicably hates nurses/babies/life saving operations, etc. They successfully shut down political debate every time.
It's entirely plausible that if there was a serious, honest and rational debate in the UK about healthcare then the country would move towards a European system. Why not? The UK aligns with European neighbours far more often than it does with the USA and that will likely continue even after Brexit.
Re: Bupa. Aren't you agreeing with me here, then? The private healthcare sector in the UK is anaemic compared to other countries because it's so hard to compete against "free". They end up trying to offer slightly better quality around the edges. They can offer complicated or expensive operations too, but people are already being forced to pay the government for them regardless of their own personal evaluation of quality or need, so hardly any market exists. Bupa is a minnow compared to its equivalents in the rest of the world, and how many competitors to Bupa can you name? The British healthcare market exists forgotten in the shadows because the NHS drowns it.
[Unpleasant facts] Unsourced Tory propaganda.
This is what I mean. It's not propaganda, it's actual reality that Labour and leftists live in denial of. Literally the first result for [nhs maintenance backlogs] is this:
"In 2018/19, the total cost of tackling the backlog of maintenance issues in NHS trusts rose by 8.4 per cent to £6.5 billion. And of this over half, £3.4 billion, was for issues that present a high or significant risk to patients and staff (see Figure 1). Now, if these numbers don’t quicken the pulse, a little more context is needed. High-risk issues are identified where repairing or replacing NHS facilities or equipment ‘must be addressed with urgent priority in order to prevent catastrophic failure, major disruption to clinical services or deficiencies in safety liable to cause serious injury and/or prosecution’"
Or you can read about it direct from Parliament (see section 2):
Note that this backlog is just to restore physical objects to an "acceptable state" (quoting the Parliament document here). It's not to actually make the NHS better than it used to be, just the cost to stop it being so degraded it's actually dangerous: "One director of an NHS trust told me that broken gutters in his hospital lead to water seeping through the walls when it rains heavily. This happens so frequently that nurses now give ‘water updates’ in their shift handovers, so incoming team members know when they will have to start unplugging electrical equipment".
That was the backlog before an epidemic of bad data and advice from government run bureaucracies destroyed the economy that has to pay for it. The government no longer has any financial strength left to tackle this issue, and risks triggering serious inflation by trying to print its way out.
There are many other places you can read about this. The NHS is decaying away because its managers are terminally incapable of making the difficult decisions management requires. Given a choice between paying down their maintenance backlog or giving nurses a pay rise, they do the latter every single time even when commanded by ministers not to. Sometimes they even fail to spend the money they were given and end up with a "surplus", just through managerial incompetence.
That's not "Tory propaganda". It's reality, and exactly how the Soviet union looked at the end of its days.
> Any whiff of ineligibility by payment is completely unacceptable, and rightly so, or we'd end up with the US disaster
Lots of European systems require e.g. payment for GP appointments and aren't anything like the US system. Likewise, the UK makes people pay for dentistry, spectacles.
> From a political point of view, we have to defend the existing system because otherwise the US one will be forced on us
This sounds like unsourced propaganda...
> Private health insurance is quite cheap in the UK compared to America because anything complicated or expensive can and will be dumped back on the public sector.
Most private healthcare in the UK covers complicated and expensive cancer treatments, including ones not covered by the NHS, so this doesn't hold water. (There are a few cheaper, less common insurance plans that don't cover cancer and are designed to complement the NHS coverage, AFAIK)
My own experience of the NHS (as a non-Brit who lived in the UK for more than a decade) is that it is inefficient at the small things (sitting in a waiting room for an hour - but being shamed if I show up 10 minutes late for my appointment) but brutally effective at big important things (treatment for life threatening diseases - worked well, but the biscuits were rubbish). I know this isn't data, but I also know that British people love to carp about the NHS, and having lived with health services in two other industrialised countries, I quite liked it.