Labour is the only party capable of tackling NHS reform, but it won’t

Rishi Sunak hopes to make the economy, where there is a plausible case that things are indeed getting better, the centrepiece of the election. Unfortunately for him, Labour’s attack will soon be focused on an issue many voters regard as even more important, and where there is no such sense of improvement – the National Health Service.

Labour has always regarded the NHS as its own, even though it was not Aneurin Bevan but Winston Churchill who as prime minister originally embraced the idea of a national health service free at the point of use and set the process in motion for its creation.

Nonetheless, it is perfectly true that in terms of its founding principles, the NHS is about as socialist an institution as they come. Not even China has anything remotely similar. The torch of communist idealism may have died in just about every other walk of life, but it still burns bright in UK healthcare.

Despite record-high waiting lists, a series of shaming scandals and growing evidence that outcomes are falling badly behind alternative forms of universal healthcare, public faith in the NHS remains remarkably strong.

The British were never happier than when banging their saucepans on doorsteps up and down the land during the pandemic in praise of our heroic NHS.

There seems to be almost no outrage or failing so great that it significantly undermines this affection. Survey after survey shows overwhelming public support for the NHS’s underlying model and principles.

Voters surely want to see improvement, but they don’t on the whole want to see the NHS abolished and replaced with something else. Any politician that even remotely suggests alternatives can expect a severe beating at the polls.

Even Reform UK, which has some quite out there and wholly unrealistic proposals for dealing with waiting lists and staffing deficiencies, shrinks from challenging the free at the point of use principle.

But here’s the point: though Labour will use every opportunity to weaponise the NHS against the Tories, it seems to be as clueless as the Government itself over what to do about this obviously failing institution.

Beyond the same old promises of getting waiting lists down, improved access to primary care, better early diagnosis of cancer, a bit more money and some un-transformational tinkering with structure, there is literally nothing of substance it’s got to contribute.

Labour has chosen well in Wes Streeting as its shadow health secretary. It would be hard to find a more plausible and obviously decent spokesman.

He is also spot on in diagnosing some of the NHS’s underlying pathologies.

“The NHS is a service, not a shrine”, he wrote in a newspaper article at the weekend. The cover up of the contaminated blood scandal is indicative of “a cultural rot that places protecting the reputation of the NHS above protecting the public”, and he promised “a decade of change and modernisation” that would put the patient first and the organisation second.

Yet he failed to draw the obvious conclusion from his analysis, which is that to transform the NHS from a national religion into a well-performing service industry. The Government must first change the funding model, so that patients can see some kind of a link between what they pay and what they receive.

It’s true that this doesn’t necessarily lead to improvement; as we have seen with the privatised water utilities, overtly paying for something is no guarantee of acceptable standards of service.

Even so, the social insurance model for universal healthcare widely practised on the Continent does seem to deliver rather better outcomes, both in standards of service and as a mechanism for enabling higher levels of funding. People generally don’t mind paying a bit more tax if they can see it hypothecated into something tangible for their money.

I don’t know enough about the policy debate of the immediate post-war period to understand why healthcare was not included in the National Insurance system established to pay for other forms of social welfare. But in any case, healthcare has been substantially paid for out of general taxation ever since the NHS was established.

There have been one or two attempts along the way to bring NHS spending into the National Insurance (NI) net – one under Gordon Brown, who partially paid for a big rise in healthcare spending via an increase in NI contributions, then a few years back via the ill-fated Health and Social Care Levy.

But neither attempt led to anything: NI has never achieved the status of continental style social insurance, and is today widely regarded as just an additional form of income tax. The contributory principle hasn’t meant anything for a long time now.

As it is, the NHS has to take its place against other spending priorities, limping hopelessly from one cash-starved crisis to the next in an age when rising healthcare expectations and the challenges of an ageing society threaten still greater disappointments to come.

Only Labour can realistically hope to initiate the necessary root and branch reform; for the Tories, any such undertaking would be electoral suicide. But there is no appetite for it in a party which, despite its Blairite pretensions, remains as wedded to the socialist underpinnings of this public sector leviathan as ever.

So we beat on, in the words immortalised by F. Scott Fitzgerald, “boats against the current, borne ceaselessly back into the past”.