Reforming the NHS

Rishi Sunak’s campaign may be flagging but he has sought to conjure up some eye-catching policies in a bid to close the gap with Liz Truss. One is the suggestion that patients who fail to turn up for GP or hospital outpatients’ appointments should pay a £10 penalty.

No sooner was the idea floated than the combined forces of NHS bureaucracy aimed their guns in its direction to shoot it down. It was unworkable, too expensive to administer and doomed to fail, they said. The Labour Party, predictably, called it a “dangerous thin end of the wedge” leading to treatment fees on the NHS.

Mr Sunak’s proposal is flawed. The obvious drawback is the difficulty of getting people to pay a fine. But the reaction is indicative of what happens whenever anyone suggests a reform to the NHS.

Instead of Mr Sunak’s retrospective plan, a better idea would be to charge a small fee upfront, as happens in most other countries with better health outcomes. This is usually opposed by those in the NHS who say the money it would raise would be negligible in comparison to the massive annual budget. So it would be. But it might help direct the national culture away from believing the system is “free” to a wider appreciation of the costs involved.

The biggest problem that politicians face in offering any solution to the NHS crisis is that they risk being denounced for undermining the fundamental principle of the system – that healthcare should be “free at the point of delivery”.

Policies to avoid missed appointments are welcome, but they will never be adopted for as long as the founding theology of the NHS, laid down 74 years ago in different circumstances, remains unchallenged.