The Daily Telegraph

Even Mrs Thatcher ducked radical NHS reform. Liz Truss must be braver

For decades the health service’s funding model has been untouchabl­e, but soon it will be untenable

- Philip johnston

We are about to learn the details of yet another attempt to get to grips with the NHS. Thérèse Coffey, the new Health Secretary and deputy PM, is the latest in a long line of ministers to be handed the poisoned chalice.

We know little as yet of what she plans beyond an ABCD of priorities denoting ambulances, backlogs, care, doctors, and dentists. (I have deliberate­ly used the Oxford comma in the last sentence just to annoy her since she has told staff that it is strictly forbidden, which seems to be the least of her worries.)

Since this is a government in a hurry we might expect something more than a grammar lesson or a sticking plaster taped over a gaping wound, though I wouldn’t bet on it. We have, after all, been here before. It is exactly 40 years since what was arguably one of the great missed opportunit­ies of post-war British politics. In September 1982, the Central Policy Review Staff, the so-called “Think Tank”, presented a report to the Cabinet proposing radical reforms of the NHS.

They would end free universal healthcare and move to an insuranceb­ased system of the sort that operated in many other countries. The paper spelled out the consequenc­es: “For the majority the change would represent the abolition of the NHS. This would be immensely controvers­ial.” You can say that again. In his memoirs, Nigel Lawson, at the time energy secretary, said it caused “the nearest thing to a Cabinet riot” that he could remember. Unusually in an era when leaks were far less commonplac­e than they are today, the report was soon in the hands of The Economist magazine, and caused consternat­ion on publicatio­n. Even Mrs Thatcher, the Great Reformer, baulked at the backlash and felt compelled to use her speech to the Conservati­ve Party conference in Brighton that year to declare the NHS is “safe with us”.

In doing so she shut down any debate over how the NHS is funded, focusing attention, as it has been ever since, on how it is structured. Rather than inject private sector discipline­s into the system through a vibrant social insurance market, ministers ever since have just poured money into the NHS and tried, unsuccessf­ully, to make it more efficient.

We are now reaping the whirlwind of that approach. When ambulances don’t arrive for an hour to an emergency, or not at all, you have a health system that is failing at its most basic level.

Even back in 1982, someone collapsing from a heart attack or a stroke would be in hospital pretty sharpish. The most recent NHS England figures show the average ambulance response time for what is known as a Category 2 emergency call – a stroke or heart attack – is just under an hour. Even if it turns up, problems await when it gets to the hospital. If beds are unavailabl­e, ambulances are parked up outside the A&E with patients on board. This means they are not available for another emergency. The knock-on effect right through the system is profound. One big problem is that beds in the hospitals are taken up by many older patients who should no longer be there but there is no one to care for them outside.

It is hardly surprising that we now have record backlogs for treatment and excess deaths substantia­lly above the average which have nothing to do with Covid. More people are dying early because they are not getting treated in time or their diagnoses for serious illnesses are delayed until it is too late. Consultant­s are reporting a growing number of patients coming to them with advanced cancers that might have been more easily treated had they been spotted sooner. The reason they aren’t is principall­y down to the failures of primary care.

The system is broken from top to bottom and yet when Ms Coffey makes her statement to MPS tomorrow, will she offer anything that will make a real difference? Money is not the issue anymore. Back in 1982 the NHS was underfunde­d compared with other health systems but that is not the case now.

Total healthcare expenditur­e (NHS and private) in the UK in 2021 was £277billion, equating to around £4,000 per person and accounting for 12 per cent of GDP, up from 10 per cent in 2019. Partly the increase was down to the pandemic. Total health spending compares favourably with other EU countries which have far better outcomes than us. But most of our funding – 83 per cent – is provided through taxes whereas in other countries there is a greater mix of state and private provision.

Spending more money on the NHS might be justifiabl­e if it produced top quality universal care. But to see it getting worse even as the funding increases is to expose the flaws at the heart of a nationalis­ed system whose founding principle is to establish equity of access even if it means lower standards of outcomes.

We know that messing about with the organisati­onal structure does not work because it has been tried umpteen times since 1982. There is even another going on right now following the promulgati­on a few weeks ago of the Health and Care Act. This introduced integrated care boards to take statutory control over budgets and marks the biggest legislativ­e restructur­e of the NHS in England for 10 years.

It moves away from an emphasis on internal competitio­n to a new framework that supports collaborat­ion and provides for a “unified, national leadership”, with more powers for the Health Secretary to intervene in decisions and direct strategy. At least if they are going to be blamed for its shortcomin­gs the Government may as well try to control it.

But will any of this make a scrap of difference if the real problem is much more fundamenta­l? If Ms Coffey wants to show she has a radical streak then let her reintroduc­e tax breaks for private medical insurance, which despite the 1982 backlash were pursued by the Thatcher government and came into force in 1990, only to be abolished by Labour in 1997. Such relief exists in other countries like Ireland which have better health outcomes than us.

MPS always lament the politicisa­tion of the NHS but that is a function of its failure. Rather than fixate on the free, universal delivery of an expensive but sub-standard service, the best way to remove the politics from healthcare is to make sure it works.

When ambulances don’t arrive to an emergency, you have a health system that is failing at its most basic level

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