Tories must be brave in reforming the NHS

The Government’s White Paper on NHS reform has the aim of making the health service “more integrated, more innovative and responsive”. The timing of its release attracted some controversy, with Labour arguing that the middle of the pandemic is the wrong moment to be contemplating what could amount to a significant reorganisation of the health service. But the Health Secretary, Matt Hancock, clearly believes that there is no time like the present.

The White Paper sets out a series of priorities for change. There is a desire to integrate services better, and encourage more collaboration between agencies. There will also be a welcome focus on preventative healthcare.

Mr Hancock spoke of removing red tape and making the system more accountable, in what has been interpreted as a rollback of the Lansley reforms of 2012. Lord Lansley wanted to move money and decision-making closer to patients, and open the system up further to private investment. Yet proponents of unwinding some of his reforms argue that we ended up with more bureaucracy than ever – only 53 per cent of the workforce is clinical – without a clear chain of command.

The coronavirus certainly shone a spotlight on what works and what does not in the NHS, with ministers complaining that, when they reached for levers at the height of the pandemic, nothing happened when they pulled them. The Health Secretary does not run the NHS under the current system, and NHS England does not directly manage the patchwork of organisations that provide healthcare, to different degrees of success. NHS England and NHS Improvement could not even say how many ventilators the country had. Mr Hancock’s proposals would give ministers more direct control over the NHS and public health.

It has to be asked, however, whether the Government is stepping too sharply back from the spirit of the Lansley reforms, which were quite different from the legislation that eventually made it onto the statute books. The principle of automatic competitive tendering, which is being taken out, was a good one – and whatever Labour says now, Lord Lansley was picking up where Tony Blair left off. Sir John Major might have created an internal market but Mr Blair sought to create something like a real market, allowing patients control over their care, empowering primary care trusts to run budgets and opening the door to non-state providers.

New Labour spent a lot of money, yes, but Blairite ministers such as Alan Milburn tried to link investment to improved outcomes. Lord Lansley was blown off this course. His plans ended up so gravely compromised that they did the opposite of what was intended. Some Tories have drawn from this error the lesson that the NHS’S structure cannot be reformed by their party – yet the whole point of politics is to create one’s own consensus through leadership and persuasion. If Conservatives believe there is a positive role to play for private providers, they should argue for it.

In a paper that was bitterly denounced by Labour this week, Dr Kristian Niemietz made the unobjectionable observation that other systems overseas have performed as well as the NHS during the pandemic, if not better, mixing public and private provision. The star performer in deploying vaccines, Israel, relies on the insurance model.

Moreover, the great success story of Britain’s coronavirus response is the vaccine rollout which, yes, has been a win for the NHS, but also for private research and private distributors. In other words, the laboratory of the pandemic response has shown us that there is another way of doing things.

The question Boris Johnson has to consider is this: does he really accept the cliché that only Labour can meaningfully reform the NHS? That there was only one moment when it was possible, under Mr Blair, and all reformers must henceforth satisfy themselves with tinkering? This does not tally with his taste for optimism or the “build back better” spirit of our age.