The NHS needs its Reformation

5 July 2008

The Spectator on reforming the NHS

Along with the rise in hospital infections, the lack of cost control within the NHS is this government’s biggest failure in health policy. In 2002, Gordon Brown, then Chancellor, accepted a proposal from Sir Derek Wanless that healthcare spending be doubled by 2022 to bring it in line with health spending in other European countries — putting a penny on National Insurance in order to pay for it. What he didn’t say was what he intended to achieve with the money; rather, spending was adjudged to be a good in itself, intrinsically virtuous. Small wonder, then, that of the extra £5 billion put into the NHS in 2004/05 alone a mere 2.4 per cent went on operations and new beds — while 27 per cent went on pay rises and 29 per cent on pensions.

Left to its own devices, the NHS would quite happily grow into a monster which would consume all Britain’s wealth. As John Appleby, chief economist of the healthcare think-tank the King’s Fund, points out: at current rates of expansion by 2046 the NHS would account for one in every two pounds spent in the Britain. And yet — even then — we would not be assured of better healthcare: spending in this area is subject to a law of diminishing returns, where huge sums are spent extending the lives of terminally ill patients by a few days.

The biggest failure of the Attlee government when constituting the NHS in 1948 was to detach healthcare from economic reality and to fail to give the new service any defined boundaries. It is about time such limits were honestly discussed. Rationing is a daily reality in the NHS, but not one that is properly acknowledged. And how are we to reconcile the public’s desire for the devolution of control to communities and individuals with its equal distaste for the ‘postcode lottery’? Everyone says they want to move beyond the ‘one-size-fits-all’ ethos of the NHS to a structure of greater diversity and variety; and yet there is still an insistence upon uniform standards. Clearly, this debate is in its very infancy.

Of all nationalised institutions, the NHS looks the safest: no party has the slightest intention of dismantling it or privatising it. We regret that the Conservative party’s position on healthcare is so timid. Lord Darzi is not the Martin Luther-style reformer that the health service needs; but nor, on present evidence, is David Cameron.