The broken NHS needs reform now, not later

Around 6.7 million people are waiting to start NHS treatment: a crisis in the health service is perennial, but these numbers seem almost apocalyptic. When an 87year-old man was forced to wait 15 hours for an ambulance – outdoors, beneath a garden football goal for shelter – his family correctly pronounced our emergency care system “broken”.

It is clear that the crisis facing British health care is existential, but one important problem is staffing, so Liz Truss is to be congratulated for suggesting measures to encourage doctors to stay in the NHS, by amending the pensions cap, and to welcome retirees back to work by making it easier to return.

The fact that neither was done sooner is an indictment of a system that is bedevilled by bad contracts and perverse incentives. The NHS is impervious to change (until recently it was still the world’s largest purchaser of fax machines), protected by a very powerful lobby, and was almost deified during the lockdown.

Covid put all health care systems under massive pressure, but the NHS’s performance since demonstrates just how fragile its foundations were even before the pandemic, when it recorded bad outcomes on afflictions including cancer and stroke survival. Contrary to everything the Left says, it isn’t wholly about how much taxpayers’ cash is spent on it.

The central problems are the service’s structure and funding model. A Stalinist, top-down structure was imposed in the 1940s on a war-damaged society grateful for what it could get. Labour pushed it through thanks to its landslide majority and by bribing GPs, and the party spun a popular tale that what they had built was the envy of the world.

Yet if that is so then why does no one else follow it? Most countries operate a mixed economy of private and public funding, a broad combination of ownership types (state, not for profit and for profit), lots of competition and health insurance schemes complemented by a safety net. Prior to the pandemic, Switzerland, which is funded through mandatory health insurance, ranked top in Europe for consumer satisfaction and was known for having short waiting lists.

It is taken for granted, here in the UK, that there will be no proper overhaul of the NHS prior to the next election: it would be a huge drain on political capital and a gift to Labour on the campaign trail.

But it is vital for the Tories to regain control of a behemoth that now appears entirely unmanaged, unresponsive, irresponsible and unaccountable. Ms Truss’s reforms sound like they would be an excellent start.