As winter approaches, the NHS appears to be on the brink of disaster, and bold and courageous action is urgently needed.
First of all, it must be recognized that the problems are not simply a question of financing. The NHS budget is huge, with the health service consuming a staggering 12 per cent of GDP. In fact, we spend significantly more on health care as a percentage of GDP than the OECD average. And yet, on many measures, including cancer and heart attack survival, we perform worse than our European counterparts.
This shows that for the NHS to be sustainable and effective, we need to focus on structural reform, rather than just cash.
Surveys show that the vast majority of people want a health service that is universal and free at the point of delivery. But changing the structure of the NHS does not necessarily mean abandoning these principles. Indeed, it will allow the NHS to serve its purpose more effectively.
Europe’s social security systems offer universal coverage, are often financed by annual premiums that resemble earmarked taxes, and, most importantly, provide free point-of-use care. “Insurance based system” is considered a dirty phrase by some. But the truth is that we already use an insurance principle to finance our health service: the National Insurance. In fact, the NHS England budget is on a similar scale to the total National Insurance take. Recent arguments about the rise of NICs show that people understand that health care has to be paid for. Involving private companies in the provision of health insurance, then, would simply mean sharing the burden (and the opportunity) between the state and the private sector.
The NHS that was created in 1948 was appropriate for the times. It is not suitable for the 21st century. This has been clear for some time, but successive Conservative governments have moved away from large-scale reform of this vital public service. They have feared being accused of trying to privatize “Our NHS”. When I was in Cabinet, I suggested appointing a Royal Commission to look into NHS reform, because I knew my party would not have the guts to tackle the issue head-on.
We owe it to our constituents to deliver the best possible health outcomes at the most affordable price, even if it means challenging some of the dogmas that have been around longer than most patients.
There are also other changes that need to happen. The NHS is plagued by an inefficient bureaucracy. Liz Truss has promised to remove a layer of management, but this may not be the answer: Inept management poses at least as big a problem as too many managers.
In fact, the 2013 Cavendish Review found that low-skilled non-clinical staff have to perform tasks that would normally be performed by nurses. To address this, the Government needs to invest in training staff to the right level.
And regardless of the financial structure, we must be more innovative with healthcare, from opening the world’s leading specialty hospitals to expert treatment of serious conditions.
Anyone who has used the NHS will not fail to be impressed by the professionalism of its staff. But the ramshackle nature of the organization is on display for all to see.
Reform is essential to the survival of the NHS. Let’s hope this is the government that saves him, not just another administration that puts him on life support.