TWO weeks ago last Wednesday, I decided to test the English NHS to destruction. While crossing the busy Chiswick High Street late in the evening, after the London launch of my new book Catalonia Reborn, I suffered a major heart attack. Frankly, I don’t remember the incident or much of the next four days, but collapsing in heavy traffic was not a sensible thing to do. Fortunately, Dan Caren, a young, jobbing actor – Chiswick is the arty and media part of London – dashed into the road and prevented a passing car or bus from rendering my brains into porridge.

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There is a weird family echo here: my maternal grandfather also collapsed (and died) of a heart attack in the middle of the road in Glasgow. In his case, passers-by ignored him, thinking he was just another Glaswegian drunk. That was deeply unfair as my grandfather was a militant teetotaller and a member of the Independent Order of Rechabites, the working-class-friendly society that avowed abstinence from alcohol – a capitalist plot to enslave the proletariat – and provided a basic form of health insurance to its members and their families before there was an NHS.

Back on Chiswick High Street, Dan’s public-spirited intervention kept the traffic at bay until a passing Metropolitan Police Armed Response Team happened by. Fortuitously, the police team were carrying a defibrillator and kept my heart (and brain) going until an ambulance arrived. As luck would have it, I had chosen to keel over close to one of the best cardiac hospitals in the UK – Hammersmith, part of the Imperial College Healthcare Trust. Confusingly, but thankfully for me, the Hammersmith Hospital is not actually in Hammersmith, but up West where I had decided to have my heart attack.

Thanks to the dedicated staff at Hammersmith, I’m still here. As in most NHS establishments – more so in London than anywhere else – the Hammersmith team were a veritable United Nations of nationalities. Attending yours truly I counted doctors, nurses and porters from (at least) Ireland, India, Poland, Sudan, Philippines, Germany and not forgetting California. To them I am eternally grateful. Of course, as we know, the Tory Government has imposed an insane limit on specialist medical immigration. The fact that this self-imposed staff shortage in hospitals is likely to kill British citizens seems oddly not to have occurred to the Cabinet.

The fantastic cardiac unit at Hammersmith – and its equivalents in Scotland – provide proof that the NHS can deliver first-class emergency intervention second to none globally. However, other parts of the NHS are in less robust health. It is a truism, of course, that an ageing population plus ever more expensive medical technology is placing financial pressures on NHS budgets. But those pressures are not the reason why the NHS in England is struggling. For starters, the UK deliberately channels less national resources to health than other major industrial countries. This is a political choice that has been hidden for years behind the propaganda façade that the UK NHS is somehow a unique social democratic priority that all governments cherish.

Health spending in the UK is circa 9.9% of GDP, which puts it slightly above the 9% average for the 30 OECD industrial nations. However, we still lag well behind France, Germany, the Netherlands, Denmark, Switzerland, Sweden, Japan, Ireland, Austria, Belgium and others. Worse, the gap has widened since the bank crash of 2008. So why does the UK political system choose to under-invest in the most basic of social priorities yet spout hypocritical nonsense about the value of “our” NHS?

Since the days of Margaret Thatcher, the basic political message from the Tories is that taxes are a “bad” thing and letting people spend their own money is automatically a “good” thing. Except that personal consumption patterns are moulded by a massive, £22 billion per annum advertising industry that focuses on getting us to buy, buy, buy whatever business wants us to acquire, the faster to make profits. Further, much consumption is done on credit – over £200bn worth and counting. Banks want you to borrow from them, not pay taxes to fund a decent NHS. I’m not saying folk should not have nice clothes and holidays – both of which actually cost a pittance to produce with today’s technology. I’m saying the UK is an economy more dominated by the banking industry than many other nations. So we are prey to a culture that prioritises private consumption over social investment, including in health.

Tory spokespersons (Ruth Davidson to the fore) harp on that the higher personal and corporate taxes in Scotland will chase skilled workers away and reduce productivity. How do they explain the fact those nations outstripping the UK in productivity have higher top rates of personal tax than the UK’s 50%: Germany (57%), Japan (55.95%), Netherlands (60%) and France (59.6%)? Or heavier corporate taxes than the UK’s headline 17% (from 2020): Germany (30%), France (33%), United States (27%), Netherlands (25%) and Sweden (22%).

Not one suggests that punitive taxation levels which ignore global fiscal competition are sensible. But equally, the lowest levels of tax do not yield the highest investment, skilled workforce or productivity – for the simple reason it all depends on how the government spends its money. Germany et al invest in infrastructure and skills to a higher degree than the UK. Result: better productivity and faster growth. Plus they invest in the social wage, including more on health. Result (at its crudest): a more satisfied, productive and healthier workforce. You get what you pay for. In the UK, we pay peanuts and get monkeys.

AT the start of June, a rattled Theresa May announced an increase to NHS England’s main budget of £20bn per annum by 2023/24 – that’s an increase of 3.4% a year, on average. That’s certainly a welcome 70th birthday present for the NHS. However, according to the independent Institute for Fiscal Studies (IFS), it barely keeps the basic NHS functioning. It is not enough to fund expanded mental health provision, public health initiatives, reduced waiting times or more spending on buildings, equipment and pay. According to the IFS, we need an annual increase of circa 4% over the next 15 years to catch up.

Which brings us back to how to make a decisive shift in spending from consumption to the NHS of probably two percentage points of GDP, perhaps three points if we are to cover home care for the elderly adequately. This will be a priority for an independent Scotland, even though NHS spending per head is already higher than in England. My betting is that it will be easier north of the Border where social solidarity is stronger. But it will take a lot of discussion and may require the introduction of a separate “health tax” so folk can see what they are paying for. We may also want to revisit the current, centralised NHS model in preference to a more decentralised system with more democratic involvement – like the old friendly societies. Hopefully this week’s National series on the Scottish NHS will encourage such a debate.

Meanwhile, my thanks to all the staff of Hammersmith Hospital.