We’re all the prisoners of an unreformed NHS

Higher taxes are inevitable so long as the unproductive health service fails to learn from the likes of Singapore

As he announced yet another big increase in taxpayer funding to the NHS yesterday, Jeremy Hunt made a bold claim for the future of healthcare in this country. “We want Scandinavian quality alongside Singaporean efficiency, both better outcomes for citizens and better value for taxpayers.”

Who could possibly disagree? Sweden and Singapore have two of the most successful healthcare systems in the world, with low mortality rates, high levels of patient satisfaction and world-leading use of innovative technology. The healthcare budget in Sweden is only slightly higher than that of the UK; in Singapore it is very much lower. They each offer universal care, with responsive primary care, faster diagnosis, better cancer survival, shorter waiting times and safer maternity wards than the UK.

Sadly, as Hunt, a former health secretary, must know, the chances of Britain’s NHS successfully reaching the high standards of Sweden or the efficiency of Singapore is precisely zero. That’s because the problems with the health service have nothing to do with money, but with the structure and funding model. And as long as those do not change, the whole country is stuck as the prisoner of a health system that demands ever-growing amounts of money for ever-worse outcomes. An ever-increasing tax burden is the inevitable result.

As reports from the National Audit Office and the Institute for Fiscal Studies this week made clear, productivity in the NHS is collapsing, despite a big increase in funds and a 10 per cent rise in the numbers of both nurses and doctors since 2019. More money has persistently failed to achieve better results.

In fact, the last time the health budget experienced a real spending cut was in 1976. Today, it consumes close to half of all day-to-day government spending, yet health outcomes continue to languish in the bottom half of international tables. The UK can indeed be described as the “sick man of Europe”, with more than seven million people on waiting lists for hospital treatment. Yet the tax burden stands at its highest for 70 years.

In citing Scandinavia and Singapore as models for the UK, I fear Hunt was being disingenuous, because he made no reference to the reason for the success of those models. In the UK, care is organised through a single massive institution, channelling huge sums of money through innumerable layers of national and regional administration, inevitably wasting billions on the way. Patients, having paid for their healthcare through taxation, are treated as supplicants, who must wait their turn for a “free” service. There is no sense of accountability and no apparent connection between payment and results.

In the Nordic countries, healthcare is the responsibility of local government, observing standards set nationally, and delivered through a combination of private, charitable and public hospitals; payment is made through mandatory health insurance. The connection between patients and provider is much closer, and the incentives for competition between providers and insurers help to drive up standards.

Patients feel more in control and are much more likely to demand, and receive, value for money.

The principles underpinning such health systems make sense to anyone with a Conservative outlook, and their success in practice would surely convince all but the most hardened socialist. So how is it that after all these years of Conservative government we are still lumbered with a dysfunctional Left-wing model that is now on the point of collapse? As the Chancellor awarded the NHS £6.6billion of additional funding yesterday, he said that he was “asking” the NHS to tackle waste and inefficiency – but with no suggestion that the cash might be withheld if the efficiencies failed to materialise. No wonder Amanda Pritchard, the head of NHS England, said she was pleased with the increase.

Perhaps Hunt thinks the public will be reassured of his good intent and aspiration for reform. He also announced that he had made a key appointment of a new advisor who will find ways to increase efficiency. Step forward Patricia Hewitt, health secretary in Tony Blair’s government. The Conservatives are now so far out of ideas that the only person they can suggest to sort out the mess in the NHS is a former Labour minister.