31 August 2022

We now have two parallel health services – a sensible reform programme should embrace that fact


For all their other failures in government, one cannot help but feel a twinge of sympathy for Conservative politicians grappling with the political problems thrown up by the National Health Service.

They are caught between mounting public dissatisfaction with the outcomes of the current system – captured in chilling detail in a recent YouGov poll for the Times – and the enduring power of the underlying NHS mythology. It’s a dissonance which allows people to believe that our health service is ‘the envy of the world’ even whilst doubting it will actually look after them properly.

Nor is that the only contradiction. Emblematic of the deeper problem is YouGov’s finding that whilst a majority of voters (including a plurality of Conservative voters) believe the NHS is receiving too little funding, a majority oppose the National Insurance increase that was supposed to deliver it extra money.

That’s good news for Liz Truss, who plans to scrap the NI hike; less good is the fact that voters also overwhelmingly oppose her plans to divert funding to social care, in order to help shift thousands of patients out of hospital beds. It is difficult to see a winning way forward except ‘more money’, which is ultimately unsustainable.

(This narrative is reinforced by charts which show various metrics turning downwards around the time of the 2010 election, the implicit argument seeming to be that health spending should be perfectly insulated from pressures on the public purse and the Tories indicted for failing to do this.)

Is this not just another area where the Tories have squandered the opportunities of office? After all, not so long ago they had achieved the remarkable feat of closing the traditional polling gap with Labour on the NHS. Might that not, as some frustrated Conservatives argue, have been a window to drive forward change?

The honest answer is probably not. The party only managed to get to convince voters it could be trusted on health by largely abandoning efforts, and even rhetorical gestures, towards reforming the NHS. It seems extremely unlikely that such poll numbers would have survived any push towards significant structural change.

If NHS reform is a ‘Nixon to China’ issue which only Labour can pull off, that is scarcely a comfort. Whilst Keir Starmer might have rid Labour of the worst of Jeremy Corbyn’s programme, we’re a long way from the days of New Labour, which happily privatised the management of an NHS hospital and, at least under Tony Blair, laid a heavy emphasis on a ‘choice agenda’ which strived towards the virtues of a private system laid out by Margaret Thatcher: treatment ‘on the day I want, at the time I want, with the doctor I want’. 

Concurrent crises make the shape of the shape of the NHS’ problems clearer than it has been in the past. As Robert Colvile recently explained in relation to the nationalised water network, the problem is that the current set-up shuts out private investment – although in this case the problem is not that health spending is losing out to higher priorities elsewhere, but simply that the demands of the system exceed the public’s willingness to pay for it.

Given that more and more British patients are going private anyway, a sensible reform programme could embrace this, integrating it into the system and allowing better-off patients to cross-subsidise the less well-off by funding their own care.

Instead, we end up with the worst of all worlds, with everyone paying eye-watering taxes for a universal system which people then pay extra to bypass entirely, with the profits and investment circulating in a parallel system that ordinary health service users can’t access.

And the rapidly-swelling ranks of those paying to opt out now includes not just the rich, but the desperate. As the FT reports:

‘And the bulk of the increase in spending is from those who can least afford it. Between 2010 and 2020, the portion of UK spending that went on hospital treatments increased by 60 per cent overall, but more than doubled among the lowest-earning fifth of the population. The poorest now spend as much on private medical care as the richest, in relative terms.’

The great danger for the Conservatives is that voters are not obliged to have long memories. If ever the crisis in the NHS grows so acute that there is finally real popular support for reform, the electorate won’t spare a government which failed to act just because those same voters didn’t support action at the time.

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Henry Hill is Deputy Editor of ConservativeHome.

Columns are the author's own opinion and do not necessarily reflect the views of CapX.