As published in the Telegraph
As winter approaches, the NHS looks to be on the brink of disaster – and bold, courageous action is urgently needed.
First it must be acknowledged that the problems are not simply a matter of funding. The NHS budget is huge, with the health service eating up a staggering 12 per cent of GDP. Indeed, we spend significantly more on healthcare as a percentage of GDP than the OECD average. And yet, on many measures, including cancer and heart attack survival, we perform worse than our European counterparts.
This proves that in order to make the NHS sustainable and effective, we need to focus on structural reform, rather than solely on cash.
Polling shows the overwhelming majority of people want a health service that is universal and free at the point of delivery. But changing the structure of the NHS need not mean abandoning these principles. In fact, it will allow the NHS to deliver on its purpose more effectively.
The social insurance systems of Europe offer universal coverage, are often funded by annual premiums that resemble ring-fenced taxes, and, crucially, provide care that is free at the point of use. “Insurance-based system” is considered a dirty phrase by some. But the truth is that we already use a principle of insurance to fund our health service: National Insurance. Indeed, NHS England’s budget is of a similar scale to the total National Insurance take. The recent arguments about raising NICs show that people understand healthcare has to be paid for. Involving private firms in the provision of health insurance, then, would simply mean sharing the burden (and the opportunity) between the state and the private sector.
The NHS that was created in 1948 was suitable for the time. It is not suitable for the 21st century. This has been clear for some time, yet successive Conservative governments have shied away from large-scale reform of this most fundamental public service. They have feared being accused of trying to privatise “Our NHS”. When I was in the Cabinet, I suggested appointing a Royal Commission to look into NHS reform, because I knew my party would not have the guts to take the issue head-on.
We owe it to our constituents to deliver the best possible health outcomes at the most affordable price, even if that means challenging some of the shibboleths that have been around longer than most of the patients.
There are other changes that need to happen, too. The NHS is plagued by ineffective bureaucracy. Liz Truss has promised to take a layer of management out, but this may not be the answer – inept management poses at least as much of a problem as the abundance of managers.
Indeed, the Cavendish Review of 2013 revealed that underqualified non-clinical staff have to perform duties that would usually fall to nurses. In order to address this, the Government must invest in training staff to the proper level.
And irrespective of the financial structure, we need to be more innovative with the health service – from opening world-leading specialist hospitals to expertly treating major conditions.
Anyone who has used the NHS will not have failed to be impressed by the professionalism of its staff. But the ramshackle nature of the organisation is clear for all to see.
Reform is essential to the NHS’s survival. Let’s hope this is the government that saves it – not just another administration that leaves it lingering on life support.