Labour doesn’t dare mention the real curse of the National Health Service.
The Darzi report ought to shock ministers into serious reform. But Wes Streeting stands alone.
FRASER NELSON12 September 2024 • 
The BBC drama This Is Going To Hurt was intended as a “love letter to the NHS” according to its star, Ben Whishaw. It looked more like a j’accuse. It shows a junior doctor asked to work impossible shifts, making horrific mistakes through sheer exhaustion – and my (immigrant) wife couldn’t understand why it was humour. Doesn’t this happen for real here? Yes it does, I replied. And we find it funny? She was studying for her citizenship test and wanted to understand this part of the British national psyche.
It’s hard to explain. Everyone says that the NHS is broken, but no one dares suggest that the free-at-the-point-of-use principle may be its main curse. The Darzi report is a devastating indictment of the betrayal of the public (and medics) by a visibly falling system. This is a country where one in five deaths are avoidable. Reform is needed, all say: but there the trail of logic runs cold. The idea that we might run our health service like other European countries is the reform that dare not speak its name.
Instead, we hark the traditional British response to NHS woes: more money! “Major” financial support is needed, said the Nuffield Trust. “Getting the health service back on its feet will require sustained investment,” said the Health Foundation. The King’s Fund (a group that lobbies for higher health spending) was specific, calling for “greater investment in primary and community services.”
The funding is there – Britain’s health service is now one of the best-funded in the world. But the real poverty is one of ideas.
For all the talk of austerity, health spending is up about a third, in real terms, over the last ten years. But when higher-risk heart attack patients call for rapid intervention to unblock an artery, they now wait for 146 minutes, half an hour longer than a decade ago. Lord Darzi, an academic surgeon, made his own visits to NHS facilities. “I was appalled to uncover that mental health patients continue to be accommodated in rooms that were constructed for a Victorian asylum,” he wrote. With “infestations of mice and cockroaches”.
The tragedy is that this dossier of such horror stories could have been written by anyone, at any time. Even the phrase Wes Streeting’s used today – that Britain risks becoming “a health service with a country attached to it” – first appeared in a Spectator editorial from six years ago.
NHS spending has risen by 19 per cent since then and the hospital workforce is up 17 per cent, and now among the highest levels in the world. But there’s 12 per cent less surgery by each surgeon (hence the waiting list).
Then, the postcode lottery. England’s NHS is divided into 229 chunks (or trusts) of scandalously varying performance. Turn up to A&E with a suspected stroke in Kent and there’s an 80 per cent chance of being given a brain scan within the hour (as is vital). In Shropshire, it’s 40 per cent. Streeting was right to point out how many problems would be solved if the best of the NHS was rolled out. But such disparities have been true for decades and no one has been able to close the gap. With its 1.5 million workforce, the NHS is just too large for any minister to control.
The basic principle that everyone should get the healthcare they need regardless of income, is observed in almost every major country in the world (with the famous exception of the United States). But even the most high-taxing and progressive countries ask patients to pay a small amount to see a doctor. This is to deter time-wasting or patients just seeking a free prescription for cheap drugs like paracetamol and aspirin (there are about 45,000 such prescriptions every day). How many GP slots would be freed up if such patients just went to the chemist?
This is what a progressive Labour government ought to be arguing. The rich can skip the system now, via £120-a-visit private GPs. The poor deserve the same service, the same choice. And this could be developed far more easily if those who could afford to pay did so. It would mean that healthcare runs more like a business – with the life-saving efficiencies this means – and more is delivered for the taxpayer’s money. Trying to reform a bureaucracy, no matter how clever the plan, won’t work because there is always such resistance.
When Sajid Javid was health secretary, he was shown a robot in a Liverpool hospital that carried out prostate surgery five times faster than a surgeon (and more safely: hence faster recovery times). Why isn’t it rolled out, he asked? Surgeons don’t like it, came the reply: it was enough of a battle to use the machine in the first place. But what about patients? Why not give them the choice between a one-month wait for proven robotic surgery – or ten months for humans? Allowing co-payments, introducing consumer and patient power, could transform such calculations.
Perhaps Streeting commissioned the Darzi review to shock his own party into dropping their ideological opposition to serious reform. As things stand, he is almost alone. Has has assembled an impressive cadre of advisers – including, controversially, Alan Milburn, a Blair-era health secretary. But it’s the rest of the Cabinet that he needs to worry about. If he was to go over the top, and call for the kind of NHS reforms that would work, who would back him? Would Keir Starmer?
When Milburn was in the trenches, he had plenty of comrades: Charles Clarke, Hazel Blears, John Reid, the old socialists who had been mugged by reality and realised that only market-based reforms would deliver. Now, Streeting stands alone: perhaps why he has ruled out any form of co-payment. It’s hard to see what other kind of reform will work.
Starmer was right to say that taxes cannot rise anymore to feed the NHS. He was right to blame his predecessors. It was the Conservatives who shirked reform, who tested the “money is the answer” theory to destruction. But having so powerfully drawn attention to the problem, it would be a great shame if Labour is prevented by its own ideology from finding a meaningful solution. DT.
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