While we’re in the mood for national self-immolation, why not throw in a storyline that the NHS contributes to our hellish national incompetence by presiding over - unleashing probably - a new and unexplained death-toll far higher than it ought to be.
Oh to be in Germany, where the health system works.
The warnings have come thick and fast, particularly in the Daily Telegraph, where Camilla Tominey leaped on data from the ONS showing that deaths in week 31 were 14.4% above the 5yr average. Commentators feasted. Allison Pearson: ‘there are now at least 1,000 more deaths than usual every week’ owing to the knock-on impact of the lockdowns. During the pandemic we were urged to ‘protect the NHS’ by not bothering it with silly things like that cancer we’re growing. Sherelle Jacobs: ‘such a devastating doom-loop has been a long time coming’.
Now there are two issues here. First, how can we avoid being caught up in the NHS’s excess-deaths tsunami? Second, could our health system be better organized, say, along German lines?
The good news: an excess-deaths tsunami is not breaking over Britain. That mortality is running slightly higher than the 5yr average is true, but the latest report puts it at about half a standard deviation from historic norms. Statisticians don’t usually get excited deviations from the norm of half a standard deviation. Not true, either, that we’re doing worse than the rest of Europe. In fact, if the UK is a statistical outlier, that is because right now our excess deaths numbers are among the lowest in Europe.
There are two sources tracking the UK's excess mortality: the UK Health Security Agency (UKHSA) and EuroMoMo (European Mortality Monitoring). Looking at confirmed data up to July 7th, UKHSA is utterly unambiguous: 'In week 26 of 2022, no statistically significant excess all-cause mortality . . . was observed.' Not in England and Wales & Northern Ireland, nor in Scotland (where statistics lag by three weeks).
The Grim Reaper hasn’t got noticeably busier since then - this is the situation up to Week 30, provisionally, according to the ONS:
EuroMoMo data updates to Week 31, and here too we find the UK has no significant excess mortality. As the chart shows, this is unusual for Europe at present: we're showing the same normality as the Netherlands, Denmark, Norway, Finland. The European countries with serious excess mortality are Spain (high excess), Germany (moderate excess) and Italy (moderate excess), with France, Portugal, Sweden, Belgium and Greece also developing an excess death problem.
Whilst it’s good to know that the excess deaths panic is overblown, no one will need convincing that the UK health system is in a dangerous mess. At the very least, Britain’s sacred cow needs a visit to a caring but clear-and cold-eyed vet.
Those knowing that Germany's health system is infinitely better than the NHS often recommend that we should re-model the NHS on that system. Would it were possible! Germany's healthcare system grew organically with its organizational roots and public ethos rooted in the medieval craft guilds. The task of replicating that from a starting point of a nationalized health-care system organized top-down by the state, is, I think, impossible. For those interested in how Germany's system works, I recommend this description.
Read it and weep at the scale of change and public ethos it would involve.
How we get from where we are to there is, frankly, anybody's guess, since it would involved the fragmentation of a centrally-'organized' bureaucracy which will resist the loss of power and resources with all the political powers at their disposal.
To achieve it would demand the defiant and hair-raising courage of a General Patton with the intellectual understanding of complexity of a Grand Master chess player, and the surgeon-like finger-sensitivity of a master Jenga player.
Simply in terms of the possible, we cannot hope to emulate Germany’s model. We will have to look elsewhere for solutions which are more adaptable.
On the other hand, there is good news: in terms of financial costs, Germany’s excellent healthcare system is not impossibly-more expensive than the UK’s: in pre-pandemic 2019, the UK spent 10.2% of GDP on healthcare, whilst Germany came in at 11.7%. In 2020, the UK’s spending rose to 12.8% of GDP. The key difference, of course, is that in Germany the compulsory national insurance scheme is exactly that - an insurance scheme rather than just another tax.
PS. If you are interested in my economics work, take a look at the Coldwater Economics website, or the sister Coldwater Economics substack site.