Johnny Leavesley is a businessman and Chairman of the Midlands Industrial Council.
How should we solve the problem that is the essential need of paying for the NHS? Carry on meeting the cost out of general taxation in the hope that, properly funded, it will efficiently meet all our healthcare demands? That has been the politically accepted expedience for decades ,and one which an unthinking consumer of its services might continue to hope for.
The NHS offers universal access to healthcare free of charge. This principle has long been immensely popular, so much so that attempts at reform are treated with suspicion by the media, medics and everyone who does not worry about its cost.
This, however, is gargantuan: £190 billlion – 20 per cent of all government expenditure in the current year, and 10 per cent of GDP. Its free at point of delivery principle is pure socialism – one not unique amongst healthcare systems; but the UK is certainly the only large economy with such an arrangement. The richest society in history, modern America, reviewed its healthcare provision with a commission headed by Hillary Clinton when her husband was president, and decided that it would not be able to afford a socialist, free healthcare model. Quite.
The truth is that no matter how much money any government is willing to spend, the NHS will not be able to satisfy the demands made of it. Our aging, growing, expectant population already has unlimited healthcare demands. This was evident even before the pandemic temporarily shifted its priorities – with pent-up demand for non-Covid ailments piling up. This problem is acute. The NHS covers the whole population, offers a huge range of services for no charge – and therefore has unlimited demand.
It is not possible to provide unlimited healthcare forevermore – we are simply not wealthy enough as a society to pay for it – and so the NHS fails the way all socialist projects fail; by the way it rations its large but limited resources.
Did you notice that in May it dropped its target of four hours to be seen after hospital admissions, to be replaced by a yet to be announced matrix of criteria? Four hours is a time period which, if kept to its limit, would be regarded as unacceptable in any other instance of service provision.
The NHS does not ration its services and resources through pricing because its constitution forbids it. Instead, rationing is imposed duplicitously through waiting times, changing clinical priorities and a hefty bureaucracy that imposes administrative barriers. All this leads to patient frustration, mediocre outcomes and often opaque injustices. The NHS is a paradox of popular mediocrity, merely because it is free at point of delivery.
It is not truly free, of course. A considerable portion of whatever taxes you pay goes towards it. You will pay higher taxes all your working life for the health service to seem free when you call upon it, mainly towards the end of life. In this sense it seems more ethical than how we pay for the care sector because it feels free.
Is it ethical, though, to continue to hide the reality of healthcare rationing behind appallingly lengthy waiting times? Debate too often prioritises sentiment for hardworking healthcare professionals ,and the panacea proposed is always more spending overall. We spend an above average 7.6% per cent of GDP (2019) and have a higher level of spending than 28 of the 37 OEDC nations (2019). The NHS is not underfunded, but does have an out-of-date funding model.
This is a structurally worsening problem, but the average NHS patient – left of centre economically and right of centre culturally – will be sceptical of any proposed reform of the system. People have come to demand and expect efficient public services, though. Leaving the funding model as it is, and increasing the budget yearly in the hope that whatever amount is thrown at it will work, is not going to deliver that.
I do not know all the answers, but suspect that a European-style insurance system will deliver greater efficiencies for a greater number of patients and, through the clarity given by a pricing model for services, be more honest. The safety net given by government to the poorest and most vulnerable can be more generous and would be the main focus of ongoing debate – because, unlike now, the infrastructure of the whole wouldn’t perpetually be in danger of imminent collapse.