31 May 2024

Will Labour break with the NHS dogma?

By Damien Phillips

Amidst the bareknuckle political brawling of the election, you’d be forgiven for missing this week’s promise by Labour to hit the 18-week NHS waiting list target in England within five years should they win power. With the official waiting list standing at 7.5m and a survey by the Office for National Statistics earlier this year suggesting the real figure is almost 10m, this is one of the biggest challenges the next government will face. 

So does Labour have the right policies (and the stomach) to put through the major reforms needed to make this happen? 

Alongside instructing the NHS to provide more treatment out of hours, which they claim could create 40,000 extra appointments each week by using weekend and evening slots, Shadow Health Secretary Wes Streeting claims he will ‘go further than New Labour ever did’ in bringing in more private sector involvement to deliver care. 

This is the key lever that Labour would need to pull to seriously address the misery of these gigantic NHS waiting lists. The vast majority of planned hospital admissions in England, around 86%, are NHS patients in NHS hospitals.

In 2021/22, only 6.2% of treatment was NHS-funded but privately provided. All this at a time when waiting lists were growing exponentially and the independent sector had been sitting on spare capacity that could have delivered an extra 300,000 treatments every year. Despite the Government establishing the Elective Recovery Taskforce in late 2022 to look into how the NHS uses private provision, mobilising the UK’s independent healthcare sector has been glacially slow.

Ditching the borderline cult-like adherence to an NHS model that features the toxic triple-whammy of healthcare provision being state-funded, state-owned and state-delivered, with all the inefficiencies and political interference that brings, seems to be the first step in creating a system which actually delivers for patients. Looking around the world, successful healthcare reforms have typically restricted the government to being only a donor of provision within a diverse healthcare market. 

One of the few countries that tried to copy the NHS model in its entirety was the Gulf state of Qatar. The former British protectorate ploughed the proceeds of its oil revenues into a very similar service to ours, only to see its state-led strategy run into a series of financial crises amidst rising costs, increased pressure on its health budget, and shortages of clinical staff – sound familiar? 

Instead of clinging to a failing system, it later opted for Singapore’s approach – where even wholly-government owned healthcare facilities, which provide subsidised care, operate as privately-run companies that compete with the private sector on service and quality. Qatari and Singaporean hospitals are operationally independent, empowered to make decisions about people and resources at the local level – free from UK-style micromanagement from central government. The result? Both states have been ranked amongst the top 20 healthcare systems in the world. 

Labour could follow suit by having all NHS hospitals become independent, privately-run organisations that are able to use as much private sector provision as they wish to get waiting lists down and have the government stick to funding patients rather than failing miserably to deliver our healthcare. 

New Labour attempted this back in 2003, only for the policy to be heavily watered-down following opposition from the Labour left and vested interests in the NHS. Any attempt by Wes Streeting to drag the NHS out of its 1940s-time warp would need an ironclad resolve to see the policy through, with the recently announced Junior Doctors’ strikes a salient reminder of the kind of opposition they might face. 

For those in favour of radical reform, there are signs that the NHS has become so dysfunctional for its own staff, let alone the patients, that there may be more appetite for change this time around. Nearly half of NHS staff are looking for jobs elsewhere, with half reporting severe burnout due to an ‘environment of constant and unrelenting pressure’ where they feel unable to do their jobs properly. The disruption of change might be more appealing if it comes with the promise of a more humane work/life balance. 

Should they encounter entrenched opposition from within the NHS, a future Labour government could always use the tactics of Labour’s former Health Secretary Aneurin Bevan, who famously bought off opposition from the medical establishment to the creation of the NHS by stuffing ‘their mouths with gold’.  The promise of significant further NHS investment might provide the space to effect reform that would benefit both the staff and patients in equal measure. 

Just as only Nixon could go to China, it may be that only the NHS’s founder can be the one to end it and the country’s suffering by finally putting our ailing healthcare system to bed.

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Damien Phillips is a Fellow of The Cobden Centre, and a specialist in international affairs and political economy.

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