We need to stop worshipping the NHS and start accounting for its true cost

I am not a fan of Sir David Nicholson, the former National Health Service chief executive. His appointment sent out a terrible signal when he was indelibly linked in a previous post to the worst health scandal this century: all those needless deaths in a mid-Staffordshire hospital.

His tenure in the top job was open to criticism, but Nicholson has recently been right about one thing: the need for a dedicated health tax to fund the service and stop us “sleepwalking into disaster”. Speaking last week at a debate in London, he accused politicians from all parties of lacking “compelling vision” for the NHS.

The former NHS boss went on to argue for a hypothecated tax on the grounds that voters would not swallow fresh tax rises needed to drive up standards without knowing where the money would be spent. This is true. But the issue goes far wider than simply winning political cover to throw some more money into the insatiable health service. As shown once again by the junior doctors strike, we need to change the terms of debate and the balance of power to achieve a modern, thriving health service.

Yes, the NHS has seemed in perpetual crisis almost since foundation but at some point something has to give. People will continue to live longer and get fatter. There will be growing numbers of people with costly complex conditions. There will be more drugs created, more treatments made available, more scientific advances, more technologies invented.

These are all things to celebrate but they tend to come with an attached price tag. Under Labour funding for the NHS almost doubled in real terms over the first decade of this century, leading to absurd claims the “tanker had been turned”. The coalition ring-fenced spending, then the Tories pledged an extra £8bn by the end of their time in office. Yet they are routinely accused of “privatisation” and “cuts”, many hospitals are in deficit, social care is suffering and even respected experts say the NHS faces its biggest squeeze in history.

More money is not the only answer to NHS problems, but it is a key part of the solution. Its budget has ballooned by more than 12 times in real terms over its history and will keep on spiralling upwards. It would swallow Britain’s entire income in half a century if allowed to rise at the same rate as under Tony Blair.

There have been suggestions of new charges used in other countries: for seeing general practioners, missing appointments and staying overnight in hospital. But even if all three levies were introduced at £10 each, they would raise only £3bn – helpful, but peanuts in health terms.

We need to change the national conversation. The nation needs to stop worshipping a flawed, outdated institution that the public perceives as free by forcing people to see the real costs and dilemmas. The only way to do this is through a dedicated NHS tax. If voters saw the sums taken from their pay towards the NHS, this might promote a more mature discussion about the costs and provision of health care.

It could also encourage better and more transparent management, ideally devolved to frontline medical teams, and make patients less sanguine about poor services, care failures and inadequate facilities. The alternative is to let a sickly patient struggle on to a sad death.