Today’s mini-budget will clearly be big news. To judge from what we have heard already, it seems likely to be the biggest and most interesting set of changes to both the macro and micro economy for many years. Change was needed. It is coming.
Inevitably therefore it will overshadow yesterday’s announcement on the NHS. Therese Coffey is probably used to that. Underrated, unshowy, quietly competent, she has got on with the unglamorous task of managing pensions and benefits since 2019 and avoided it generating new political headaches. Her promotion is very much deserved.
Even someone as capable as Ms Coffey, though, must have had qualms at the unenviable task of devising a plan for the NHS backlog. Her announcement was probably the best possible in the circumstances – a target for waiting times for GP appointments, and some more support for obvious weak points like getting patients out of beds and into social care or improving call handling. This may not help waiting lists much, but may make the NHS experience slightly less demoralising and unsatisfactory.
We all know the problems go beyond the impact of the pandemic. In my 57 years on this planet, I don’t think I have ever seen the same GP twice in succession. Too much experience with hospital treatment shows there is little continuity of care there either, so mistakes happen – one reason why keeping relatives out of hospital can be so damaging. And there are just too many high-profile cases of catastrophic medical error – the Ockenden report into maternity services being just the latest – striking for the indifference and inability to learn from experience they sometimes reveal.
The hard figures paint the same picture. Survival rates for serious illnesses tend to be worse than elsewhere, with the UK in the bottom third of the league table of advanced countries for most outcomes.
Nor is this much to do with funding. In 2019, the last pre-pandemic year, OECD figures show we spent 10.2 per cent of GDP on healthcare, against an OECD average of 8.6 per cent: more than Spain, Italy, Australia, or New Zealand, about the same as the Netherlands. In 2020 we were actually the biggest spenders anywhere apart from the United States. Of course, we could always spend more, as France and Germany do, and that might well be sensible, but it is hard to make the case that the NHS is actually underfunded.
What is unusual about our system is the way we run it. We are the only large country where most health services are organised and paid for by government. The NHS, with its 1.4 million employees, is the third largest employer in the world. If it ever merged with the social care system, as some want, it would be 3 million strong. Organisations of this size simply cannot be managed from the top and their workforce cannot be planned by the Treasury on the basis of guesstimates years in advance. If you try, you get shortages, inefficiency, and no incentive to change practices to get better outcomes.
These facts are known, but so far in this country we have chosen to look away from them. As a result, tens of thousands of people die earlier than they need to every year. We should all be angrier about this than we are.
But I say “so far” deliberately. For the first time in my political lifetime, maybe things are changing. People seem to recognise the NHS has in fact had a lot of money. There is huge exasperation at the difficulty in seeing a GP. I also think that over the years more and more people have been exposed to European insurance-based systems, on holiday or living abroad, and can see they are also free at the point of use and yet often work better and more efficiently than ours.
It is crucial not to let these sparks of intuition go out. The Government can begin by encouraging debate about other health care models and being less defensive of the NHS. It can also encourage innovation: I can set up an online appointment booking system overnight – so why do so many GP practices not do so? Paying GPs by appointment, rather than by person on the list, might also help, as the rapid growth of private GP services suggests.
I don’t suggest that taking on root and branch reform of the NHS is the top immediate priority. Serious change will be the work of a generation. But it has to begin somewhere. It is also most likely to last if both major political parties are involved. It is encouraging to see that sensible people in the Labour Party, like Wes Streeting in the Spectator yesterday, recognise the problems are not just about funding.
There is a huge opportunity for the country here. If we don’t take it, if everyone goes back to their comfort zones, with Labour equating every change with “privatising the NHS”, and the Tories scared off reform and letting a parallel and genuinely private sector grow instead, then it will be easier for everyone politically. But many more people will die needlessly. For once, let’s not pass on the other side.