Malpractice lawsuits against the U.K. National Health Service have been rising for some time. Many explanations for the trend have been invoked, including declines in care quality and the creation of new policies that make receiving compensation for medical injuries easier. But I think those and other wonky factors are but little blips in a much longer historical arc. I can explain the source of the change most easily by telling a story.
I was staying at my club in London and woke up to find that there was neither any electricity or warm water. I washed my face in icy water and shaved by the light of my mobile phone before stumbling down to the breakfast room. There I learnt that all the other members had endured the same unpleasant surprise. The stoves and refrigerator were not working either, meaning that the morning meal was both meager and unappetizing.
If this had been a hotel, everyone would have been angry and demanded a refund from the management. But it was our club, so none of us complained. Indeed the mood at breakfast was rather jocular. The club is us, we are the club. What were we going to do, sue ourselves?
That’s how a whole generation of British people felt about the National Health Service NHS. It wasn’t an alienating system run by outsiders. It was theirs. An elderly friend who passed away recently had his final years made shorter and more painful by an NHS doctor’s medication error. Of course my friend was not pleased, but it never occurred to him to sue the NHS. In his eyes, that would be like suing his own club.
Younger Britons see the NHS more as a hotel. It’s a government-run system of which they feel they have no stake. They are its customers, and they expect good service from this entity, to which they feel little emotional connection. If the NHS makes a medical mistake — and sometimes even if it doesn’t — some of these customers feel that it is perfectly reasonable to seek individual profit at NHS expense. As NHS staff see this change, they regard their patients with more suspicion than they had to in prior eras. The likely effect, in addition to the growing number of lawsuits, is an increase in wasteful testing and double-documentation that health care systems use to reduce the risk of malpractice claims.
The change in British culture regarding feelings towards the NHS is one of those phenomena that is very hard for health policy analysts to address and understand. No amount of studying laws, regulations and procedures would reveal that part of what made the NHS work so well for so long was a widely-shared sense of “us-ness”. The cultural surround of the NHS after the war was unique, and it is now fading. That unfortunately will make the NHS more like the US health care system, in which a cultural surround of individualism and profit-maximization makes suing one’s doctor seem a perfectly natural thing to do.