Another day, another ridiculous Boris Johnson statement. This morning, the cabinet discussed whether the NHS was to become like Netflix, and predictably everyone has got very excited. It's worth having a look at what actually happened at the meeting, though. The official readout is that Sajid Javid — not Johnson ― updated ministers on 'the scale of the challenge post-pandemic — saying we had a Blockbuster healthcare system in the age of Netflix'. He then elaborated on this: 'He said it was no longer simply an option to stick with the status quo. He said large-scale changes were needed in areas such as the use of technology and data to help frontline workers deliver the high-quality service the public expects.'
What is he on about? Is he really planning to turn the health service into a monthly subscription service that ends up in a fair bit of debt while not really giving you what you were looking for anyway? It's quite clear that what Javid is talking about here is technology and the problems that the NHS is having in adjusting to the digital age. It is not a ridiculous statement to make, nor is it something with which the NHS top brass disagrees. In October the newly-appointed chief executive of NHS England Amanda Pritchard told MPs on the Health and Social Care Select Committee that a large section of the NHS was lagging behind the modern world:
“We would absolutely agree that if we want to achieve a modern, efficient health service, we will not do it if we are not able to put that digital underpinning in place. There are two big things that are the focus at the moment. One is frontline digitisation. About a fifth of trusts in the NHS are still largely paper-based. We have some that are absolutely at the other end, but that is a very important thing to be able to fix if we are to achieve some of the interconnectivity we were talking about earlier.
Paper-based trusts: at least Blockbuster had VHS. There are lots of reasons why parts of the NHS have been slow to embrace even basic technology. One is the siloed way in which those parts often work, without reference to others — though Covid and in particular the vaccine rollout have done a great deal to crack some of those silos open. But another is that capital spending on health in the UK is extremely low in comparison to other European countries: about half the share of GDP. This means we have much lower numbers of CT and MRI scanners, for instance. But it also means that IT — which makes up around 10 per cent of capital spending in NHS Trusts — is rather under-resourced.
In her Select Committee appearance, Pritchard went on to say 'the point you will be all too aware of is that we can only go at the pace we have funding available'. That's hardly a surprise from an NHS boss: they ask for money more often than they have hot dinners. But this is where things really get awkward for the Netflix NHS: after today's cabinet meeting, the Prime Minister's official spokesman clarified that 'there is no further investment beyond obviously... the funding envelope already set out by the Chancellor'. The money — if there is any real money to underpin this 'transformation’ - seems to be coming from a planned £4.5 billion annual saving through productivity, which is, if not a magic money tree of a similar species to tackling tax avoidance and cutting red tape, quite an ask.
In summary, it’s a typical Boris Johnson policy on the day after his bruising vote of confidence result: eye-catching without much substance. Still, it's much easier for everyone to miss asking the really revealing questions about capital spending because they are so busy making up scare stories about a Netflix-style subscription to the NHS.