The NHS cannot be immune to reform

The popular myth about the NHS is that it is free – an act of charity by the generous welfare state. And yet all the while that politicians, doctors and even patients affirm this fantasy, it continues to grow and expand well beyond what is affordable. It is the largest employer in Europe, costs the UK £145 billion a year and, according to new figures, is swimming in debt. It is time to face some uncomfortable truths.

This week finally saw a settlement in the dispute over junior doctors’ contracts. The proposed deal that Jeremy Hunt thrashed out – a tribute to his patience – is cost-neutral and will, hopefully, provide fresh staffing at weekends. But it is only the end of the beginning. The conflict was triggered by a growing need to update the NHS to serve patients better while keeping spiralling costs under control. Many doctors went on strike because they had concerns about patient safety that Mr Hunt did his best to address. The British Medical Association, however, saw a chance to pitch for higher pay while dressing up the dispute as a revolt against Tory economics.

The BMA’s cynical strategy did garner some popular support – and the blame for that lies with politicians. For decades Labour has argued that all the NHS needs is more money, weaponising the issue to win elections. In the 2000s, the money came rolling in – much of it absorbed by building, staff increases and wages. The Tories, desperate to end Labour’s monopoly of the issue, announced that they would ring-fence NHS funding. Few politicians have dared question the sustainability of a system directly funded by taxpayers as users live longer and more of them are lifted out of tax.

To be fair, they might be more willing to have that conversation if they thought there was the public will for it. Alas, there is a wider assumption that we here in Britain are lucky to have “our” NHS – that it is both compassionate and efficient. Appalling flaws in care, such as data showing that only one in 10 hospitals provides 24/7 expert attention to the dying, indicate that there are logistical limits to the compassion. And financial reality proves that efficiency is a fraud. Figures released by NHS Improvement show that the health service in England has run up a record deficit of £2.45 billion. The scale of this overspend, the largest in history, is probably masked by accounting tricks. Unless there is serious, rootand-branch reform, there will surely be further squeezes on the quality of care, and conflict between staff and the Government.

Whenever a debate begins about change, Labour cries privatisation. In fact, the problems often lie with management of resources. There are queues at A&E because people cannot get to see a GP; hospital beds are blocked by those who should be in social care. And bringing in private providers, while retaining the principle of free at the point of delivery, could relieve pressure on the state behemoth, as would encouraging a healthier private insurance market.

There is another myth hampering reform: that there is no alternative to the way that the NHS is run. On the contrary, other developed countries operate systems that, at the very least, perform as well as our own. They provide universal coverage while integrating private and publicly owned assets – financed by a mix of taxation and personal insurance. Most important of all, they tend not to treat patients as charity cases – but as consumers with every right to expect value for money.