Stop scrimping, Theresa May – or the NHS’s 70th birthday will be its last

This is it. The bailiffs are at the door waving the red-ink bill. Pay up or else. For eight years the government has stuck the NHS bill behind the clock but now the crunch has come. Will July’s NHS 70th birthday be a celebration or a funeral? The Institute for Fiscal Studies (IFS), grand truth-teller of fiscal facts, alongside the Health Foundation, an NHS pulse-taker, declare the service needs – absolutely, unequivocally needs – funds that add another £2000 a year per household in tax over the next 15 years.

That’s a sum to drain the blood from any chancellor’s cheek. But this government has only itself to blame for the unpaid bill, with eight years of flat funding, harsher than the NHS has ever known. With social care, it needs 4% more a year: hard demographics show 4 million more over-65s will cause 40% more hospital admissions.

Battle rages between the treasury, No 10 and the health department, with the chancellor proffering half what’s required. Look, says the treasury, how the shroud-wavers warned the NHS would implode every year since 2010, but on it goes, each winter the “worst”. OK, so waiting lists soar, cancer waits stretch, a shortage of doctors and nurses cripples services – but frankly, where’s the outcry? We’re even ahead in the polls! Yes, the NHS is getting worse ratings, but so what? We saw off the junior doctors; they won’t try that again in a hurry. People have died in A&E waiting to be admitted – but there hasn’t been any one scandalous case to shock the public. Yes, the Mail sometimes demands a hyper-expensive cancer drug to prolong the life of some dying patient, but we can handle those one-offs. Besides, we can always point to inefficiencies, even after these lean years: why do procurement costs and the number of post-operative bed-days still vary wildly? Tough it out! Austerity forever! Are you MPs true state-shrinking Tories or lily-livered statists?

Against that complacency stands the other politically reality: an NHS growing weaker, offering worse and less, failing in modern technology, trailing behind international survival rates. This is the “choice in a generation” says IFS director, Paul Johnson. Politically, the all-party Commons health and social care committee “wholeheartedly endorses” the report: 5% more a year is needed immediately, 4% in future once the damage is repaired. The NHS has survived starvation better than expected, but its demise is a slow slide crisis and a political price will eventually be paid for a squalid service.

The prime minister has fixed upon the 70th birthday for its rebirth, but half measures will signal an ending, not a new beginning. These figures are not a negotiating salvo, but a bare minimum. If that £2000 per household by 2034 is an eye-popping sum, that’s still only a quarter of the extra growth households will get by then. In polls people swear they would, personally, pay more for the NHS. But politicians fear that tax-raisers get punished on election day.

Every low accounting trick has been tried, with trusts ordered to switch capital funds to current spending, leaving nothing to replace old scanners or fix leaking roofs. Thumb screws are applied to managers, forced to sign impossible “control total” budgets, with high profile executives taken and out and shot to terrorise the rest – none more high profile than Bob Kerslake, recent head of the civil service. Here was a reign of terror indeed if even he could be fired from King’s College hospital. But they can’t fire everyone.

This is a national identity question. Is Britain staying in the same league of civilization as the other west Europeans? If so, the NHS needs 9.9% of GDP, instead of the current 7.3% to bring us to their equivalent levels, which Labour did – only to see us tumble back after 2010.

Ask what makes people proud to be British and the NHS is forever top, as a fundamental principle of equality for all. We fail miserably to abide by that principle in the rest of life, split by deep political ambivalence on injustices in wealth, income, housing and life chances – but equal care in sickness is a bedrock. Why? For selfish reasons, because everyone uses it, is born in it, dies in it, relies on it to scrape us off the road and save us from crisis. We are proud not to be American – and we know paying privately is cripplingly more expensive. Rightwingers yearning for top-up co-payments and private insurance are rejected utterly by the public: for health, only collectivism works.

Will Theresa May finally put her foot down and claim the NHS for her party? If yet again she fudges, ducks and triangulates, then she gifts it back to Labour, its only begetters and its natural guarantors.