Boris Johnson is seizing the moment. He is sensitive to the charge that he has broken his word over Leave and the NHS, and that the Government has no plan to give the system a Brexit bonus. Hence his call for the health service to get £100 million extra – and its timing. Jeremy Hunt wants a ten year plan for the NHS and higher spending with it. Sarah Wollaston has called for an all-party commission, and is supported by Andrew Mitchell, Nicholas Soames and Nicky Morgan, who wrote on this site on the subject yesterday. George Freeman, another signatory to Wollaston’s all-party letter, has mulled social insurance. Nick Boles has proposed turning National Insurance into National Health Insurance. Nick Timothy suggests a Royal Commission.
The winter pressures on the NHS, the long squeeze on local authorities, anxieties about mental health and disability funding, the failure of last summer’s Conservative Manifesto proposals for social care…who knows what combination of these factors, plus patient and family experience, are driving the current debate about the future of social care and health? At any rate, the Foreign Secretary is piling in to a discussion that has suddenly become very live. Another committed Brexiteer, Jacob Rees-Mogg, made a similar point yesterday in his debut Moggcast for this site.
Suggestions of a parliamentary or a royal or a special commission of some kind are scarcely new. This site proposed an Affordability Commission five years ago, to look at healthcare, social care and pensions in the round. The collapse of that manifesto social care policy, plus the Government’s lack of a workable Commons majority, all but rule out radical change to the system, for which Ministers have no mandate for in any event. All they can hope to do is contribute to a gradual change in the conversation, and make Hunt’s new title more than honorary by giving him scope to join up social care and healthcare a bit better.
Nigel Lawson once said that “the NHS is the closest thing people have to a religion”. That successive reforms have transformed it since Bevan’s day – not least under Alan Milburn and New Labour – makes his point no less right. But it reveals an impasse. On the one hand, voters are attached to the free-at-the-point-of-use model, not least for fear of what might replace it. On the other, there is no hard evidence that they are willing to cough up the necessary funding in higher taxes. Hence Boles’s suggestion of hypothecating a tax that some voters already pay.
It is possible to accept that “one fifth of spending on health makes no or minimal contribution to improved health outcomes” while also believing that spending on health, social and mental health care should be nearer the levels of many of our European neighbours. As the King’s Fund put it, “the UK is currently a relatively low spender on health care – as the Barker Commission pointed out – with a prospect of sinking further down the international league tables”. But those other European countries have systems that are not based on the principle of being free at the point of use. Ministers will be wary of giving a commission questions to address, for the obvious reason that they may not like the answers – as with Dilnot. But what is the alternative?