Memo to all Tory Ministers: If you daren’t be bold on the NHS you’ll be on the critical list
From a leading peer, this stark health warning...
The public will not put up with this crisis for ever
ONE law for the rich. Another for the poor. It i s the ultimate symbol of inequality, injustice and unfairness. But that may be what lies ahead for our NHS. If you are wealthy, the doctor will see you now. If not, go to the back of the queue.
When he set up the NHS in the 1940s, Labour Health Secretary Nye Bevan had a startlingly simple idea – to save people from financial stress at their time of need. And that became the founding principle of the NHS – ‘free at the point of use’.
But that wonderful dream is turning into a recurring winter nightmare – for patients, who wait for hours on trolleys in corridors, and for politicians, for whom the NHS has become the ‘third rail’ of politics – touch it and die.
Any Conservative who thinks the best their party can do about the NHS is to shut up (because it is a Labour issue), should consider how many Tory majorities were lost in the South East at the June Election in constituencies along the strike-hit Southern Railway routes.
Passengers who suffer delays and cancellations feel they are treated with contempt. Patients may soon feel the same about delays and cancellations of operations. Any Government that believes the public will put up with this for ever will pay a heavy price at the next General Election.
The Prime Minister will have no shortage of advisers who will say: ‘All is well. Or if it is not well, it is at least under control.’ In other words, keep kicking the can down the road and let your successor worry about it.
How wrong they are. To be rushed to hospital in an ambulance is a harrowing experience. To then be left waiting outside is bewildering.
A year ago in The Mail on Sunday I set out the solution – a cross-party Royal Commission on the NHS. These bodies are designed to address issues ‘of great national importance in which the tribal warfare between the political parties is an impediment to the national interest’. It is hard to think of a better example than the NHS.
Why do we need a Royal Commission rather than just spend more money? Because the forces behind these winter crises will not go away.
First, a larger population – the increase from 2010 to 2020 is the biggest in history. Second, an older population – last year, for the first time, people aged 65 and over outnumbered those aged 16 and under.
YES, spending is part of the answer – and the period between 2010 and 2021 will see the biggest drop in NHS spending as a share of GDP since the service was founded. But we also need a simple answer to a straight question. Where is the money coming from?
The Treasury gets the blame for the endless ‘Tory cuts’. But it knows there is no simple solution to these huge pressures. People accept the NHS needs more money. But they will not pay more tax because they think they are paying enough. And they will not pay to see the doctor because it is supposed to be ‘free at the point of use’.
So the Chancellor has the strongest motive of all to bring a long-term solution. Yet Ministers, scarred by the experience of the Andrew Lansley reforms, feel unable to suggest radical changes – and would struggle to get public backing even if they did.
A Royal Commission can cut through this Gordian knot. It would have the power to summon witnesses – under oath – to get to the bottom of what is ailing the NHS, and to recommend changes that put it in a position to deliver the best outcomes over decades.
Tomorrow, the Centre for Policy Studies, which I chair, will publish a detailed remit for a future Royal Commission on the NHS. But there has already been support from the medical profession. Several former Health Secretaries have also offered their endorsement.
A Royal Commission could report with recommendations – fully costed – from which the public and the political parties could choose. Far easier, some Ministers might think, to keep their heads down. But leaving the NHS alone, or spending limited amounts to patch up the most serious problems, is a recipe for long-term catastrophe.
It is also contaminating the Government’s reputation. The Director of the Centre for Policy Studies appeared on BBC local radio recently to explain our plan for a Royal Commission.
The presenter seemed puzzled – weren’t the Tories running down the NHS in order to privatise it? This was said not as an accusation, but presented as an accepted fact. The truth is that the Government has done a creditable job keeping the patient stable – funding has risen, in real terms, year after year. But the time has come to strive for a full recovery, to acknowledge that a system set up 70 years ago needs to be re-examined and put on a sustainable footing, both financially and institutionally.
THERE is, of course, an obstacle. A Royal Commission needs to be cross- party, or rather, to sit above the parties. But the NHS is Labour’s political weapon of choice, the stick with which it can beat the Tories. Why would it disarm?
There are several answers. Refusal to participate would give lie to Labour’s claim to want the best for patients. The terms of the remit could be clearly set to ensure it was impossible to claim the plan represented ‘privatisation by stealth’.
The Commissioners would have a duty to examine alternative revenue sources for the NHS beyond general taxation, and to ensure their proposals were affordable, sustainable and fully costed. But the fundamental principles of the NHS would remain sacrosanct.
When Theresa May became Prime Minister she gave a stirring address about her mission to resolve unfairness and injustice. It is still her deepest driving motive.
If she moves the national debate on the NHS from a focus on short-term fixes to a longterm cure, she will deserve to sit by Nye Bevan in the pantheon of the health service’s greatest heroes.