the times | Thursday November 26 2020 1GM 31Comment
NHS should make better use of its billions
Ministers need to ensure that extra money going to the health service helps patients rather than boosting inefficiency
Buy prints or signed copies of Times cartoons from our Print Gallery at timescartoons.co.uk or call 020 7711 7826resources was picked up by
successive governments.
Tony Blair realised that reform
was vital and that making scarce
resources produce better results for
patient health is the opposite of
heartlessness, even when many in
his own party sought to block him.
David Cameron tried, too. But such
was the kicking he received for
attempting even modest reform that
no one has dared try since.
And that is almost a decade ago
now.
So on we go, congratulating
ourselves on our British
exceptionalism, failing to ask why, if
the NHS really is the envy of the
world, no other leading nation has
adopted its model.
This complacency extends beyond
health. Interest in public service
reform has all but vanished in Britain
after decades where it was hotly
debated. Instead, we are in a new
statist era where success is measured
by the amount of money flying out
of the door.
If we will not tolerate wholesale
NHS reform, blending the public
and private systems used without
public hysteria by the French, the
Germans and the Singaporeans,
then we can only hope that
someone, somewhere in government
starts to take an interest in where the
money is going.Yet it ended up scrambling around
and paying inflated prices to get
gowns and masks from abroad.
As new money pours into a largely
unreformed system, should there
not be a Whitehall push like never
before to work out how the extra
cash should be best used to
deliver more?
The managers at NHS England
will claim that before Covid, NHS
productivity, the rate of output
compared to what we put in, was
running ahead of the rest of the
economy. That’s not saying much,
though. Poor productivity bedevils
the British economy. Doing a little
better than something as woeful as
British productivity is nothing to
boast about. As David Maguire of the
King’s Fund, the independent health
charity, pointed out last year, much
of the gain in NHS productivity
came down to wage restraint from
2010, which kept costs under control.
But NHS pay is now going up, as a
necessary thank you for work done
during Covid-19.
We might blame these problems
on the inadequacies of our political
class but that’s unfair. Over a long
period they tried. In the 1980s,
Margaret Thatcher proposed
reforms. Although there were
mistakes, such as contracting out
hospital cleaning, her determination
to make more efficient use ofmeaningful reform of the NHS.
There will be no switch to social
insurance or even the slightest
interference with the work of
something so widely admired. Any
politician trying it will be stoned to
death in the public square. The
pandemic will only make the NHS
more popular.
Even so, it seems odd that we can
spend so much in rapidly
accelerating amounts and be soincurious about what is working and
what isn’t in this centralised system,
and what lessons there are to learn
from the crisis.
Worryingly, of the £6 billion that
was announced yesterday, only
£300 million is set aside for
improvements to the social care
system, where shortcomings were
most apparent in the first phase of
the crisis. As for primary care, many
Britons will have experienced GP
surgeries shutting up shop early in
the pandemic and offering a patchy
remote service in return. On NHS
procurement, one of the advantages
of the institution being so large is its
supposedly vast purchasing power.O
ne of the strangest
aspects of the Covid-19
crisis has been the
government’s slogan
urging us to “protect the
NHS”. Surely the point of a health
system is that it should protect us
rather than the other way round?
That’s why we pay our taxes.
Those working tirelessly on the
front line certainly have protected us.
But that isn’t uniquely British.
Medical professionals in all sorts of
countries with functioning health
systems honour their oath to protect
life and treat the sick.
Perhaps the reason we overlook
the weirdness of that slogan, putting
the emphasis on protecting a system,
is that to the British the NHS is
everything. A healthcare system
funded from direct taxation and free
at the point of use is the closest thing
many people have to a national
religion, as the former chancellor
Nigel Lawson once observed. Even
though it is not quite national in theway we imagine — Scotland’s system
carries the same name but has been
separate since its creation in 1948 —
it is central to how we like to think
about ourselves on these islands.
Inevitably, Rishi Sunak gave the
NHS more money in his spending
review yesterday. Another £6 billion
will be spent on the health service,
the chancellor said. Its budget for
this year had been £143 billion, which
was already up from £114 billion in
2009-10, so don’t fall for the
surprisingly prevalent myth of cuts.
Any minister, like the chancellor,
who has ambitions to be prime
minister must pledge to protect the
NHS. The public relations
consultants who came up with that
slogan in the spring knew what they
were doing. Voters’ pride in the NHS
is off the charts. A YouGov poll two
years ago found that 87 per cent of
Britons were very or fairly proud of
the health service. Only the fire
service was narrowly more popular.
Both institutions were by some
distance more popular than the royal
family, the police, the Boy Scouts and
Girl Guides, and the BBC. The
House of Commons (of which only
28 per cent were proud) and the
House of Lords (a mere 21 per cent)
came bottom of the table.
That being the case, there is no
chance of the people in those least
popular institutions attempting anyAttempting even
modest reform earned
Cameron a kicking
Iain
Martin
@iainmartin1