Here’s an idea to save the National Health Service: get rid of GPS

Left and Right need to face reality if they want the NHS to help patients for another 70 years

Albert Einstein is credited with the observation that insanity is doing the same thing over and over again and expecting a different outcome. He could have been describing the NHS. This great national institution celebrates its 70th anniversary next year and is pretty much funded and organised along the same lines as it was in 1948. Since then the population has grown by 14 million; average life expectancy has risen by 20 years; scientific advances have made treatments that were once unimaginable commonplace; and consumer-driven expectations have replaced the sullen acquiescence of yore.

At the same time, nursing has become a profession for graduates, junior doctors work fewer hours, GP surgeries are over-subscribed and their appointments system is a frustration to many. It is harder to see a doctor, few of whom visit at night or work at weekends; and as a consequence A&E is expected to perform a “gateway” function it was never designed for.

Of course, the NHS has not stood still. The introduction of an internal market allowed health authorities to manage their own budgets; hospital trusts have pooled resources to reduce costs; and primary care has been overhauled, if not necessarily for the better. Gleaming new hospitals have been built, primarily through PFI deals, and most people report high levels of satisfaction with the treatment they receive.

But there is something intrinsically wrong with the NHS and everyone knows it. Lord Kerslake, the former head of the Civil Service, stepped down as the chairman of the King’s College Hospital NHS Foundation Trust in London this week shortly before it was placed in “special measures” by NHS bosses because of a spiralling deficit. They said he was asked to leave the post a few days before he announced his resignation.

Because of his former role in charge of Whitehall, his departure caused something of a stir. He penned a valedictory article for The Guardian which was seized on by the Left to bolster demands for yet more cash to be poured into the NHS from the general taxpayer. Lord Kerslake, although a cross-bench peer, is an adviser to John Mcdonnell, the shadow Chancellor, so his broadside had a partisan edge. In the Commons yesterday, Harriet Harman said changing the faces of management at King’s would not save it from the impact of “brutal cuts”.

But an objective reading of what Lord Kerslake had to say tells a different story, assuming he means it. Here was someone who had been in government for most of his working life and had now realised that many of the assumptions he had taken for granted about the NHS no longer applied. Despite major reforms in the way King’s had been run, and big savings in its budget, “the inexorable pressures of rising demand, increasing costs of drugs and other medical supplies” had made it impossible to keep up. He ended his piece with these words: “Fundamentally our problems lie in the way that the NHS is funded and organised. We desperately need a fundamental rethink.” Whatever the NHS’S problems, just pumping in more money was clearly not the cure.

In all the coverage of Lord Kerslake’s removal, this plea for a root-and-branch analysis of how we deliver health care in the UK seems to have been mysteriously overlooked. The Left ignores it for fear of challenging the cherished founding principle of the NHS – that it is free at the point of delivery. The Right disregards it because to say anything risks inviting the gravest accusation of all: privatising the NHS.

The Conservatives have shied away from radical change ever since a row in 1982, when a report by the Central Policy Review Staff proposed introducing compulsory private health insurance and a system of private medical facilities that “would, of course, mean the end of the National Health Service”. Margaret Thatcher went to that year’s party conference and promised that the “NHS is safe with us” and effectively vetoed any further look at fundamental reform.

What Nigel Lawson once called “the nearest thing we have to a national religion” lived on. Just as Lutherans 500 years ago thought the Church was acting for the benefit of Rome and the clergy, not worshippers, so the NHS feels like the property of its high priests – doctors, nurses, administrators, ancillary workers and their trade unions – not patients and their families.

It needs a Reformation. What matters is not whether the system conforms to the ideological tenets of the late 1940s (still embraced by many in the Labour Party as immutable, like a holy writ) but whether the country is able to get decent health care. As Lord Kerslake said in his article, this will not be possible without fundamental change.

There is an irrational hostility on the Left towards any private sector involvement that might deliver a public good. This year is the 40th anniversary of Motability, a charity set up to provide cars for the disabled, which has succeeded because banks, car manufacturers, insurers, retailers and others used the market to build an enterprise designed to help the people who use the scheme, not those who run it. Motability now operates the biggest car fleet in Europe and has benefited more than four million disabled users.

If we want health care to remain available to all for another 70 years, then some serious thinking has to be done and hoary old dogmas jettisoned. For instance, does the current structure really work any more? Do we need GPS to give us a 10-minute once-over and point us in the direction of a consultant when we have apps, robots, online self-diagnosis and over-the-counter medicines that will allow us to provide our own primary care? Is there an entire tier of the NHS that could be removed? Should we not at least explore alternatives?

Trying to get the two major political parties to agree even to look at radical change is pointless. They would let the car crash into the wall before admitting they knew the brakes were faulty. The only answer is an independent inquiry like a Royal Commission. Since he has identified the problem, perhaps Lord Kerslake could chair it.