The NHS is irreparably broken. Everybody knows it. Indeed it is hard to go to any gathering without hearing tales of woe about cancelled operations, lengthening waiting lists, GP shortages and late ambulances.
Horror stories that would once have elicited sympathetic tut-tuts from those who found the service perfectly adequate are now topped by experiences that almost defy belief. A friend who was told to wait 40 weeks to see a consultant for a complaint that turned out to be cancer might not have survived without getting a private diagnosis that led to speedy treatment (on the NHS, it should be said).
For people unable or unwilling to seek private consultations such waits are terminal. How can anyone defend a health system that effectively sentences people seeking its help to death? Yet many do because it is free at the point of delivery. Although a recent public attitudes survey showed a collapse in satisfaction with the performance of the NHS, when it comes to its essential creed – that you do not pay directly for treatment – support is overwhelming.
And why wouldn’t it be? Given the choice between paying for something or getting it for “free”, which would you take? The other founding principle, that the NHS should be paid for from taxes, also has massive public support. Again, if someone better off than you can pay for your health care why not? These two shibboleths have so taken root in our national psyche that they have poisoned any rational thought. What we want, surely, is a health service that works, delivers care to all, has enough beds for treatment, sufficient well-trained staff and good outcomes.
In a modern economy those should be the minimum expectations. Yet the NHS does none of these, despite having stuck rigidly to its founding principle since 1948. The situation in primary care, with GPs told to work late to avoid A&E chaos, is a national scandal. By any measure, the system is fractured and yet the country continues to be persuaded that to question its underlying concepts is tantamount to apostasy.
For the Left, the NHS is the one remaining legacy of the post-war Attlee socialist dispensation and they will defend it to the death. For the Tories, it is the one nationalised industry that they have been too terrified to privatise for fear of inviting political disaster.
The Conservatives are now in the worst of all worlds. Having spurned chances to reform the NHS properly over the last 12 years, they now preside over a busted system for which they will be blamed.
Billions of pounds have been poured into the NHS in recent years to no avail. True, the pandemic has made things far worse in terms of delayed diagnoses, cancelled operations and an exodus of staff; but the writing was on the wall long before Covid appeared.
Boris Johnson has been desperate to wrest the NHS away from Labour’s proprietorial grasp. “We are the party of the NHS now,” is the new Conservative mantra. It may have sounded like a good idea to outflank Labour by claiming ownership of a national treasure but not when it has been shown to be made of pewter, not silver.
The next two years leading to the general election will see a relentless bombardment of the Tories for everything that has gone wrong in the NHS. They haven’t put enough money in; they have allowed staff training to diminish; they are in hock to private health companies; they don’t use it themselves – every line of attack will be deployed. We know this because we have seen it before.
It is fear of precisely this criticism that has paralysed decision-making around the NHS for so long. Ministers thought that by pumping more money into health care, funded by an increase in the taxes that people say they are happy to pay (but aren’t, especially if the result is poor), they could defuse the ticking NHS time bomb always likely to blow up in their faces.
In the event they are now just waiting for the explosion, wedded to an unreconstructed system for which the only remedy is to feed its voracious appetite with yet more money.
The Tories can enter into a bidding war with Labour if they want but the Left will always trump them because they are happy to load the costs on to the very taxes that Rishi Sunak wants to cut by 2024. Good luck with that, Chancellor.
The upshot is that no one in a position to do something about this mess will risk trying to clear it up. The Tories talk about instilling greater efficiency in the system but they have done so for years without making much difference. Everyone rails against the top-heavy bureaucracy in the NHS but nothing is done to change it.
The alternative, social insurance-based approach followed in many European countries with far better outcomes than ours is simply pooh-poohed by the Left as hidden privatisation or a betrayal of the true 1948 religion.
Suggestions that we should emulate other countries where things are done better are met with tendentious statistics purporting to show that the NHS provides better value for money compared with its counterparts.
If you ask die-hard supporters why, if the NHS is so good, it has not been copied, they maintain that elements are present in other health systems. But the full, nationalised, centralised, inefficient, tax-based monster that we have created exists nowhere else.
We are unable to break free from a creaking 74-year-old model of health care that no longer delivers what we want and yet are too craven to let someone do anything about it.
Nor is there an obvious forum for rectifying matters. Parliament is useless because the political debate soon turns into partisan name-calling and a Royal Commission would take years to set up.
Here is an idea. The terms of reference for the forthcoming Covid inquiry are currently being drafted after a public consultation. Inevitably, it will focus on pandemic planning, preparations and responses.
But given that “protecting our NHS” was the main aim of the lockdowns, the inquiry could usefully examine the extent to which its structures, systems and funding are contributing to the gradual collapse of health care in this country. This can no longer be ducked.