It’s time to end the NHS funding taboo
Reform or die. The Prime Minister’s stark warning about the future of the NHS is said to be the harbinger of the greatest overhaul of the system in its 76-year history. But unless we know what the reform entails it is impossible to know whether Sir Keir Starmer’s doom-laden words will be matched by effective action.
He set out a litany of problems that everyone has long known, without Labour in Opposition offering to help repair the damage.
Suddenly, in government, the NHS is a basket case and one created totally by the Conservative Party. If this purports to be a serious analysis then there is no prospect whatsoever of any meaningful improvement.
Sir Keir said the founding principle of the NHS, dating to 1948, of a publicly funded system free at the point of use is non-negotiable. In which case he will fail, because the core problem is that it is a socialised, nationalised system. Waste is built into its very fabric.
Sir Keir quoted extensively from a report compiled by the surgeon Lord Darzi, which he said was a “raw and clear-eyed” assessment of the parlous condition of the NHS.
But there is an irony here. Lord Darzi has done this before. In 2008 under the last Labour government, he was appointed health minister and asked to conduct a “next stage” review of the NHS. His report High Quality Care for All sought to map out a future for the health service that would bring radical change to what it delivers and how it delivers it.
Improvement would be driven by local clinicians, armed with better data on the effectiveness of their own work, spurred on by financial incentives and by the choices of well-informed patients rather than by top-down targets. All of these are being proposed again as part of the Government’s 10-year plan.
Labour is blaming the Tories who were in government for the past 14 years for what Sir Keir called its “unforgivable” condition, even though the amount spent on health has risen by one third in that time to around £190 billion now.
With the Office for Budget Responsibility warning that the national debt is soaring to unsustainable levels, Sir Keir says there can be no more money without reform. On past form he is unlikely to stick to that.
But here is the nub of the problem. Lord Darzi said that if the same amount had been spent on infrastructure in the NHS as in other similar countries there would have been enough money for dozens of new hospitals, better treatments and the like. However, that assumes the money would have been well spent; and the problem with the NHS is that vast amounts are wasted because it is a nationalised industry.
This is not a crisis caused by the Tory party but one that is decades in the making because we persist in following a model that is outdated, cumbersome, unproductive and seemingly impervious to change.
In his speech to the King’s Fund in London, Sir Keir said he was not merely setting out a list of failures but addressing the specifics of reform. Yet, beyond a long list of platitudes, we were no clearer by the end of what it might involve.
We needed to “fix the plumbing before turning on the taps”; the NHS was “broken but not beaten”; it needed “major surgery not sticking plasters”. But its fundamentals were not going to change, so how does this plan differ from the dozens we have had over the past three decades?
He said the NHS will use new technology to empower patients, as if that is not already happening. New drugs to help combat obesity may help eliminate some diseases like Type 2 diabetes.
Sir Keir made no mention of the other driver of demand, a rising population, which has grown by 10 million in 25 years, primarily because of immigration, and is set to rise by millions more for the same reason, placing further pressure on the NHS.
Sir Keir says the NHS must reform or die, yet it remains top-heavy with bureaucrats and feels like it is run for its staff, not patients.
The Prime Minister refuses to do the one thing that will keep a public health service alive and move to a hybrid social/private insurance system, as operates in many countries with better outcomes than here. This is surely worth debating, yet any discussion has been shut down for ideological reasons and a sentimental attachment to a 76-year-old model that no longer works.