Today’s mini-budget will clearly be big news. Judging from what we’ve already heard, it seems likely to be the biggest and most interesting set of changes in both the macro and microeconomics for many years. A change was needed. Is coming.
Inevitably, therefore, it will overshadow yesterday’s announcement in the NHS. Therese Coffey is probably used to that. Understated, inconspicuous, quietly competent, she has carried on the unglamorous task of administering pensions and benefits since 2019 and prevented it from generating any new political headaches. Her promotion is well deserved.
Even someone like as capable as Mrs. Coffey, however, he must have balked at the unenviable task of devising a plan for the NHS backlog. His announcement was probably the best possible under the circumstances: a target for waiting times for GP appointments and some more support for obvious pain points, like getting patients out of beds and into care. social or improve call handling. This may not help waiting lists much, but it can make the NHS experience a little less daunting and unfulfilling.
We all know that the problems go beyond the impact of the pandemic. In my 57 years on this planet, I don’t think I’ve ever seen the same GP twice in a row. Too much experience with hospital treatment shows that there is no continuity of care either, so errors do happen, one of the reasons keeping family members out of the hospital can be so detrimental. And there are too many high-profile cases of catastrophic medical errors (the Ockenden report on maternity services is just the latest) that are surprising in the indifference and failure to learn from experience they sometimes reveal.
Hard figures paint the same picture. Survival rates for serious illness tend to be worse than elsewhere, with the UK in the bottom third of the advanced country league table for most outcomes.
This also has little to do with funding. In 2019, the last year before the pandemic, OECD figures show that we spend 10.2% of GDP on health care, compared to an OECD average of 8.6%: more than Spain, Italy, Australia or New Zealand, almost the same as the Netherlands. In 2020, we were actually the biggest spenders anywhere apart from the United States. Of course, we could always spend more, as France and Germany do, and that might be sensible, but it’s hard to argue that the NHS is actually underfunded.
What is unusual about our system is the way we run it. We are the only large country where most health services are organized and paid for by the government. The NHS, with its 1.4 million employees, is the third largest employer in the world. If it were ever to merge with the social care system, as some want, it would have 3 million people. Organizations of this size simply cannot be managed from the top, and the Treasury cannot plan its workforce based on estimates years in advance. If you try, you get scarcity, inefficiency, and no incentive to change practices for better results.
These facts are known, but until now in this country we have chosen to look away from them. As a result, tens of thousands of people die earlier than necessary each year. We should all be angrier about this than we are.
But I say “until now” deliberately. For the first time in my political life, perhaps things are changing. People seem to recognize that the NHS has, in fact, had a lot of money. There is great exasperation at the difficulty of seeing a GP. I also think that, over the years, more and more people have been exposed to European insurance-based systems, on vacation or living abroad, and can see that they are also free at the point of use and, however, they often work better and more efficiently than ours.
It is crucial not to let these sparks of intuition go out. The Government can start by encouraging debate about other models of health care and being less defensive of the NHS. It can also encourage innovation: I can set up an online appointment booking system overnight, so why don’t so many GP practices do it? Paying GPs per appointment, rather than per person on the list, could also help, as the rapid growth of private GP services suggests.
I am not suggesting that undertaking comprehensive reform of the NHS is the top immediate priority. Serious change will be the work of a generation. But it has to start somewhere. It is also more likely to last if both major political parties are involved. It is heartening to see sensible people in the Labor Party, like Wes Streeting in yesterday’s Spectator, acknowledge that the problems are not just about funding.
Here is a great opportunity for the country. If we don’t accept it, if everyone goes back to their comfort zone, with Labor equating every change with “privatising the NHS”, and the Conservatives scaring away reform and letting a genuinely private, parallel sector grow, then it will be politically easier for all. But many more people will die unnecessarily. For once, let’s not go to the other side.