The PM once knew money wouldn’t cure the NHS’S ills. What changed?

Blame our unreformed health service, not the virus, if Britain goes back into lockdown this winter

Who said this? “It is all very well to treat the NHS as a religion, but it is legitimate for some of us to point out that… it is letting down its adherents very badly.” That was Boris Johnson, speaking in the House of Commons, in April 2002. A few hours earlier, Gordon Brown had delivered a Budget in which he raised National Insurance contributions to pay for a record increase in funding for healthcare.

Mr Johnson went on: “It is wrong of the Chancellor to set his face against the experience of other countries that have a far better record of healthcare provision, a far better life expectancy, and a far better record of dealing with cancer and coronary heart disease.

“Those countries do so not just because they spend more money on health but because they do not rely exclusively on a top-down monopolistic health service of the kind that we have in this country. The Chancellor has decided that there is only one model for healthcare in this country – the NHS model – and he has decided that it is unimprovable except through the addition of more taxpayers’ money and platoons of auditors to swell the ranks of the administrators.”

As far as I know, Mr Johnson was compos mentis at the time, he was 38 years old so his mental faculties were fully developed, and he had the added virtue of being correct in his analysis. Yet, here he is reaching for the same wrong approach that he so eloquently denounced nearly 20 years ago. More pertinently, he is doing so in precisely the same circumstances, in response to the near collapse of the NHS in the teeth of an epidemic. Memories are short. We easily forget that we have been here before if not quite in the same circumstances.

In January 2000, the country was hit by a serious flu outbreak that overwhelmed hospitals and triggered a political crisis for Tony Blair’s Labour government, which had made a great deal of its commitment to the NHS during the 1997 election campaign.

Less than three years later, here was health secretary Alan Milburn making an emergency statement to MPS to explain why patients were being left overnight on trolleys and all of London’s intensive care beds were full.

The number of cases of flu had quadrupled over Christmas, Mr Milburn said. “Emergency admissions to hospitals have increased as a result: there have been more than 200,000 in the past three weeks alone, and there has been an increase of almost 30 per cent in the past two months. The evidence that we are receiving from hospitals is that the patients who are being admitted are more ill than normal and are staying longer than normal. Many hospitals that had planned to start surgery have decided to delay until the immediate emergency pressures subside.”

All this sounds horribly familiar, though no one during the subsequent exchanges proposed shutting down the country in order to arrest the spread of flu. A few days later, Tony Blair was interviewed by David Frost in what became known as “the world’s most expensive breakfast”. To avoid a repeat of the crisis, he promised to bring health spending up to the European average by 2006 through annual cash increases of around 5 per cent in real terms each year. It was this pledge that Mr Brown was honouring in the Budget announcement that Mr Johnson denounced.

Mr Blair said the extra cash was conditional on reforms of the NHS that never materialised other than at the margins. His chancellor set his face against any changes in funding arrangements, for instance by moving to an insurance-based system. Had they done so, we might have been there by now. Instead they accelerated the development of NHS Direct and embarked on an ill-fated contract renegotiation with GPS whose baleful impact we are feeling to this day.

Mr Blair had won power in 1997 on a strong platform to “save the NHS” so its inability to withstand a flu epidemic was a severe embarrassment. A review was commissioned from the banker

Sir Derek Wanless, and he proposed increasing spending from £68 billion then to £184 billion a year by 2020. Its average core funding is still below that figure, though this year’s investment is well above because of Covid.

Wanless anticipated a shortfall in nurses and GPS by 2020 and argued for better integration of health and social care for older people in order to free up expensive hospital beds for more patients. Yet one of the great failings exposed by the pandemic is the low capacity in the system to deal with events like this.

In 2000, Mr Milburn said it was important to increase the number of intensive care beds, which would only be achieved when the influx of trainee nurses started to enter full-time service. One of the great mistakes in modern healthcare was Project 2000, introduced by the Major government, whereby nurses were no longer trained in hospitals but at university. This effectively barred less academic entrants and took trainees away from the front line, where they were sorely needed last year and will be again this winter.

These capacity shortfalls meant the Nightingale hospitals were never used, not because of a dearth of beds but of clinical staff. Why has this not been planned for – for instance, by diverting trainee nurses from college to the wards? If we lock down again this winter, it will not be because of the disease itself but because the NHS cannot cope with the predictable pressure of Covid and flu.

One thing about the 2002 Budget is that it was very popular. Opinion polls registered a 16-point Labour lead and laid the basis for another election win in 2005. This will not have been lost on the poll-fixated Mr Johnson who, after the initial hoo-ha over breaking a tax promise (for which, incidentally, he also castigated Labour in 2002) will hope to be similarly rewarded by voters for whom the NHS has been elevated to an almost God-like status.

But as he said in that 2002 speech: “I wonder how the Chancellor can call the NHS the envy of the world, or whatever fatuous phrase it was that he used, when... more people than ever before are now being forced to use their own resources to pay for operations. People are being driven to use private medicine in despair at the NHS. There should be no shame in pointing that out.” Indeed not.

Mr Johnson will hope to be rewarded by voters for whom the health service has been elevated to an almost God-like status