Britain's Labour Party came to power in 1997 pledging to "save" the country's decrepit and over-stretched National Health Service. The once-vaunted system of taxpayer-funded health care for all, founded by the postwar Labour government in 1948, had degenerated into a chaotic, inefficient monolith as the burdens on it increased and its resources diminished. Then, in January 2000, a flu outbreak exposed exactly how sick the NHS really was. Thousands of flu victims jammed doctors' offices and hospital emergency rooms; routine operations like hip replacements and cataract removals had to be canceled to make beds available for the acutely ill. Newspapers groaned with reports of patients abandoned in hospital corridors because there was nowhere else to put them. An estimated 20,000, mainly elderly, people died. David Cummings, a retired food technologist, now 74, fell ill with food poisoning at the height of the crisis. Nurses initially tucked him up in crisp white sheets on a ward in Princess Margaret Hospital in Swindon, about 100 km west of London. Three hours later, they turfed him out and onto a trolley in a corridor. "I stayed on that trolley for three nights," he says, adding with typical British understatement: "It wasn't at all comfortable."
It wasn't at all comfortable for the government of Prime Minister Tony Blair either, which faced a daily avalanche of gruesome headlines, public outrage and blame for having failed to fix the system. At the time, Britain spent only 6.8% of its GDP on health care, compared to a European Union average of nearly 9%. Apart from the flu outbreak, there were record numbers of patients waiting for simple procedures to treat varicose veins and hemorrhoids, while mortality rates for heart disease and cancer were among the highest in the developed world.
Blair prescribed a raft of changes more doctors and nurses, shorter waits for treatment, new hospitals and an all-out attack on killer diseases and promised to raise Britain's health-care spending to the E.U. average by 2006. "It was almost a no-brainer," says Blair's former health adviser Simon Stevens, now president of health-care firm UnitedHealth Europe. "For a left-of-center administration, the answer was always going to be to increase spending with reforms."
In its campaign for a third term, Labour has made the NHS a key component of its re-election bid, promising to maintain higher spending, further reduce waiting lists, offer patients a choice of hospitals and shift up to 15% of care to the private sector. The NHS is at the top of voters' concerns, and the legacies of Blair and Labour will be judged just as much on whether they succeed in revitalizing the NHS as on their decision to go to war in Iraq or their management of the economy. So, has Labour delivered on its promise to save the NHS?
The statistics look good. Britain will this year spend 8.5% of GDP on health care, a figure set to reach 9.2% in two years. The NHS's annual budget has doubled to $170 billion since 1997. Tens of thousands of new doctors and nurses have been hired. Crumbling prewar facilities have been replaced, in part thanks to injections of private finance into the system. Access to treatment for cancer and heart disease has improved, as have survival rates. In England, where five out of six Britons live, the number of people waiting for treatments like knee surgery and hysterectomies has fallen sharply, though opponents say the figures are fudged. The verdict from Jennifer Dixon, director of policy at the King's Fund, a health-policy think tank in London: "On the whole, [Labour] has achieved what it set out to achieve."
Yet, there are still recurring complaints. Centrally imposed government targets have reduced waits, but have also distorted priorities by encouraging hospitals to first treat patients who have waited longest, sometimes disregarding the seriousness of their ailments. The Conservatives' health spokesman, Andrew Lansley, promises, "On the first day of a Conservative government, we will abolish all political targets imposed on the NHS." NHS staffers now number 1.3 million, Europe's largest workforce, but the system is still short of radiologists, surgeons and clinical psychologists. And for some patients, the cure has proved worse than the disease an estimated 9% of inpatients acquire infections while in England's hospitals; some 5,000 people die every year as a result. The rate of infection by methicillin-resistant staphylococcus aureus (MRSA), a bacterial infection that doesn't respond to conventional antibiotics, is among Europe's highest an estimated 955 deaths last year were attributed to MRSA. "We're in a state of disbelief that hospitals may kill us not because of illness, but because they're dirty," says Vanessa Bourne of the Patients Association, a consumer group. "Patients can't understand why this isn't top of the priority list."