The Independent View

Time to fix the ‘national sickness service’ once and for all

Editorial: An NHS that works for those who depend upon it should not be too much to ask – or beyond the wit of politicians. The next government should prioritise finding long-term solutions for its systemic problems

Wednesday 27 March 2024 18:51 GMT
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28 March 2024
28 March 2024 (Dave Brown)

Satisfaction with the NHS has sunk to its lowest level since the British Social Attitudes survey began measuring it in 1983. Only one in four people (24 per cent) are satisfied – a 29-point drop in the past three years – and 52 per cent dissatisfied.

The findings, analysed by the King’s Fund and Nuffield Trust think tanks, are no surprise after the pandemic, a wave of strikes that have dragged on for far too long, and a series of NHS scandals. Understandably, the public’s main concern is about waiting times; they are much happier about the treatment they (eventually) receive.

Despite the criticism, people still have faith in what the former Conservative chancellor Nigel Lawson called “the closest thing the English have to a religion”. One survey participant put it well: people “love our NHS,” as the stickers and badges say, but “it’s a bit of a toxic relationship”. They do not want a different system but want their NHS to work better. It should not be too much to ask for.

A large majority of people agree with the NHS’s founding principles: it should be available to everyone; free at the point of use; and primarily funded through taxation. Indeed, 48 per cent of people would support the government raising taxes for the NHS, a figure that rises to 62 per cent among the highest quartile of the income range. That is something for Rishi Sunak to reflect upon as he tries to squeeze in a third cut in national insurance on the eve of the election.

The NHS takes up an ever-increasing share of public spending to cope with an ageing population. Its long-term workforce plan will require a real terms increase in spending of 3.6 per cent a year but this will put huge pressure on non-protected government departments, which face cuts of about 3.5 per cent.

Inevitably, some doubt whether a system created 76 years ago can ever be made fit to cope with today’s demands. Critics complain about a bottomless pit, that the huge injection of taxpayers’ money is not matched by productivity improvements. They point out that the NHS is likely to employ one in every 11 workers by 2036-37, up from 1 in 17 at present.

It is true that money is not the only answer; reform is needed, too. We have a national sickness service; it would be a much better use of resources to spend more on prevention and community care, which would mean a switch away from hospitals.

Politicians talk a good game about reform, but their record is patchy. When Mr Sunak ran for the Tory leadership in 2022, he proposed a £10 fine for missed GP or hospital appointments. As prime minister, he abandoned the idea after objections from the British Medical Association.

Satisfaction levels are even lower for social care, at just 13 per cent. There is no solution to the NHS’s problems that does not include social care, since the inability to discharge patients from hospitals adds to the pressures on them. Regrettably, care is unlikely to feature in this year’s general election campaign; both main parties are wary of tiptoeing into a minefield that detonated Theresa May’s 2017 election hopes, and money is tight. But to rescue the NHS, the next government will have to find a long-term solution to the social care crisis.

Better communications with the 7.5 million people on NHS waiting lists would help them without costing much. Technology has the potential to transform health care through AI, robotics, genomics and data analytics while giving patients a much better experience.

Jeremy Hunt’s announcement in this month’s Budget of £3.4bn to modernise the NHS’s creaking IT systems is welcome, though such promises have been made before – including by him as health secretary. This time, it must really happen. Although the NHS has about 50 different electronic record systems, a new data platform being introduced will not include GP or social care. It should.

Satisfaction levels with the NHS reached a record high by the time Labour left office in 2010. If Labour forms the next government, the lack of money at its disposal will make it very hard to repeat the trick.

Labour promises a shift to prevention. If that happened, it would be welcome. Sir Keir Starmer might have to consider doing what Sir Tony Blair and Gordon Brown did in 2002 – they raised national insurance to “save the NHS” after building public support for the move. But this would have to form part of a contract with the NHS in which money was accompanied by reform and higher productivity.

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