Daily Mail

How bitterly ironic that it’s taken a Labour minister to prescribe the free market medicine our NHS so badly needs

- by Christophe­r Snowdon ■ Christophe­r snowdon is head of Lifestyle economics at the institute of economic Affairs.

The image is unforgetta­ble. In the words of Britain’s top A&e doctor, the UK’s hospitals are now ‘like lobster traps — easy to get into and hard to get out of’.

Dr Adrian Boyle, the new president of the Royal College of emergency Medicine, is so concerned about the abysmal quality of care on offer in NhS hospitals that, he told the Mail this week, he is ‘desperate’ to avoid his elderly parents ever being admitted to one.

A few statistics justify his fears. Twelve-hour waits are common in A&e, and one in five hospital beds is ‘blocked’ by patients who no longer need them but cannot be discharged because a crisis in social care means there is no care package in place.

With hospitals running at a record 94.3 per cent occupancy,

this year’s NhS winter crisis is set to be a shocker.


Dr Boyle is right, of course. But why? how can it be that after 12 years in power, the Conservati­ves don’t seem to have a clue how to treat the sickly health service, beyond pumping it with ever-more gargantuan transfusio­ns of public money?

The chaos across the NhS betrays a terrible lack of political imaginatio­n — one for which we are all suffering.

even without the outrageous 17 per cent pay rises that nurses are demanding, taxpayers have never before shovelled out such enormous sums to the NhS.

Last year alone, we spent no less than £277 billion for all healthcare — £229 billion of it on the NhS. That is 12 per cent of the UK’s entire GDP and more than £4,000 for every man, woman and child in england. It’s also well above the average of richer countries in the Organisati­on for economic Co-Operation and Developmen­t (OeCD).

If we enjoyed world- class healthcare for our largesse, then this eye-watering bill might just about be worth it.

But the NhS provides poorer value for money than healthcare systems do in many comparable countries.

For example, Britain has just 2.5 hospital beds for every 1,000 people. That is less than a third of the number in Germany; or even Bulgaria.

Britain also has fewer doctors, nurses, CT scanners and MRI units per capita than similar countries. We also have poorer survival rates for most cancers. And, as Mail readers know all too well, getting a GP appointmen­t has become an endurance sport.

Record staff shortages, overburden­ed A&e department­s and planned strikes are all contributi­ng to the chaos.

So the ‘cash cure’ is clearly nothing of the sort: overall, our system lags behind even the likes of Chile and tiny estonia in health outcomes.

Radical surgery is clearly needed. But successive Tory government­s, terrified of being accused of ‘selling off the NhS to their rich friends in the City’, have baulked at taking the scalpel to the bloated bureaucrac­y underminin­g the delivery of care.

Instead, Tory ministers have outdone themselves to boast of spending ever more of our money on Britain’s ‘worldbeati­ng’ health service.

This pathetic prostratio­n before the NhS idol needs to stop. It’s time for the heretics to reveal themselves. And, mercifully, there is a sign that they are willing to do so — even if Tory ministers will not.

Scandal after scandal involving poor care in trusts across the country have revealed how unaccounta­ble this behemoth, which employs 1.3 million people, has become.

Now Labour’s Shadow health Secretary, Wes Streeting, has raised the possibilit­y of introducin­g what the NhS badly needs: market forces to improve accountabi­lity, competitio­n and outcomes.

earlier this month, Streeting said: ‘ You won’t hear me pretend that the NhS is great; that somehow the timeliness and quality of NhS care — which is currently appalling — is the “envy of the world”.’

In September, Streeting — who was successful­ly treated for kidney cancer last year — was even more blunt: ‘Labour can’t just rely on the same old hackneyed slogans on the NhS. We’ve got to demonstrat­e that it’s rescue and reform.’

Streeting even added that the private sector could be ‘one of the levers’ for tackling the huge treatment backlog.

It is both ironic and depressing that Labour, and not the supposedly free-market Tories, are the ones willing to have an honest debate about bringing a dose of commercial realism into our ailing NhS.

historical­ly, of course, any attempt to introduce competitio­n and private funding into the NhS has been met with shrieks of ‘ Look at America’ — as if the U.S., where decent healthcare is unattainab­le for the poorest, is somehow the only alternativ­e to the NhS.


That’s rubbish, of course. The NhS may have been suited to the statist post-war era in which it was created, but no one would design a healthcare system in this way today.

Instead, if Britons are truly willing to consider reform — and I believe we are, for all the Tories’ timidity — we should look at countries such as Australia, Germany and holland.

Crucially, healthcare remains free at the point of delivery in these nations, but private and public funding are merged to produce far better outcomes than we get in Britain.

One option would be to dismantle the monolithic NhS into various bodies, all competing with each other.

For example, certain hospitals could compete with others for patients and staff.

Nurses or doctors could choose to work in one hospital rather than another, and patients could choose where to go for their treatment. The magic of the market would improve innovation, prices and service.

This could be funded either by a compulsory private health insurance system, selffunded or provided by employers from workers’ salaries, with the Government stepping in to pay for those who could not afford it.

healthcare would always remain free at the point of delivery: apparently an unassailab­le shibboleth in Britain.

Or the Government would pay for health insurance through general taxation, contractin­g out the healthcare itself to competing suppliers.


None of this is particular­ly shocking. The NhS is already using private clinics to cut waiting lists, while paying private locum doctors and nurses absurd wages as they don’t have enough full-time staff.

The NhS may be the last bastion of socialism, but most patients don’t care about ideology (though you can be very sure the NhS unions pushing for a general strike do). What patients want is doctors, not doctrine.

And most people can see that using private providers works: we happily go to Specsavers and pay for an appointmen­t and a reasonably priced pair of glasses, rather than waiting weeks for NhS specs.

My fear, however, is that the Tories lack any capital to bring about such radical reform. Yes, they have made some efforts while in power: first under health Secretary Andrew Lansley then Jeremy hunt. But these were topdown reforms, simply adding more smothering bureaucrac­y and management to the NhS.

Next year, the service turns 75. The kindest thing is to move it gracefully into retirement — and find a fitting replacemen­t for this century.

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