George Maggs is an Associate Lecturer at the University of the West of England.
Has there ever been a time when the NHS hasn’t been in ‘crisis’? After a quick Google search, the only year this century I was unable to find a story containing the words ‘NHS’ and ‘crisis’ in the title was 2009. And that’s probably just because I wasn’t looking hard enough.
Despite any criticism of the NHS seemingly able to turn people who would normally consider themselves cosmopolitan liberals into jingoistic nationalists, clearly something is amiss, and it isn’t just a matter of money. The health service needs comprehensive structural reform.
So what should a Conservative solution to the perpetual NHS crisis look like?
Well, I’m sure most of us wouldn’t wish to be starting from here. The health service isn’t something a modern Conservative would create if he or she were starting from scratch. It is a universal truth that large government monopolies are costly and inefficient. To put it bluntly, politicians are generally pretty rubbish at running anything, let alone hospitals.
However, despite the example of many continental systems which consistently outperform the NHS, an insurance-based scheme simply will not fly here. The NHS, despite its many flaws, is a much-loved British institution. People just will not accept any arrangement that isn’t funded through the tax system and free at the point of use. Moreover, conservativism as an ideology seeks to maintain our historic institutions, and the health service with its current funding model should be no exception.
We therefore have to find a way of making the current tax-funded model work. Here’s how:
First, the health service should be taken out of the hands of politicians. During the 1970s and 1980s, privatisation swept across the Western world as it became acknowledged that governments were terrible at running heavy industry. During the 1980s and 1990s, a global consensus emerged that central banks should be made independent because monetary policy was too important to be left to political parties.
Well, if car production and tweaking interest rates are too precious to be governed by squabbling politicians, then the NHS most certainly is. Like the Bank of England, our health service should be publicly owned, but politically independent, and run by people who actually know what they’re talking about.
This makes sense (most importantly) from a practical point of view, but also from a political stand point. Voters consistently trust Labour with the NHS more than the Conservatives. An independent Health Service would permanently remove Labour’s ability to ‘weaponise’ the health service at election time.
Second, the NHS should have its own independent funding stream. Theoretically, we already have a hypothecated tax system. National Insurance Contributions (NICs) are supposedly set aside for health and pensions. In reality however, they just go into the pot with everything else. But with an independent health service, this NI money could completely dodge the Treasury and go straight into NHS coffers.
The Office for Budget Responsibility (OBR) forecast that for 2017-18 NICs should raise a total of £130.3 billion. For the same year, total health spending in England is expected to hit £124 billion. So the numbers are already more-or-less aligned.
Having the NHS directly funded by NICs would provide taxpayers with much more clarity about what they are paying to help keep the NHS afloat.
However, under such a system, the amount that the NHS receives would fluctuate according to the rate of employment. In a recession, it would receive less, just as the government does. Like the government, the NHS should therefore be given the power to issue debt securities (within strict limits), to smooth over the economic cycle. This would mean the government would no longer be responsible for bailing out the NHS during a ‘crisis’, giving the service incentive to maintain and improve efficiency and productivity.
Finally, the NHS should have a clear and transparent constitution describing exactly what it is for, and what it is not for. Recent years have seen the NHS assume responsibility for services far beyond the intentions of its creators. The NHS should be there to make us better when we are mentally and physically ill, not to enhance people’s standard of living beyond a basic level.
Procedures like IFV, gender dysphoria treatment and cosmetic enhancements beyond what is necessary to lead a normal and fulfilling life should not be provided by the taxpayer. It is a National ‘Health’ Service. The clue is in the title.
Be under no illusions, despite all the excitement in Westminster about Brexit, what people in the country really care about, and what will win or lose the next general election, is the state of our nation’s public services. To stand a chance of defeating Jeremy Corbyn in 2022, the government must offer a positive plan for a sustainable NHS. These proposals would be a good start.