Politicians must understand that solving the healthcare crisis is fundamental to economic recovery
With the world still trying to piece itself together after a once-in-a-century pandemic that threw almost everything we took for granted out of the window, it’s hardly surprising that healthcare is centre stage in the General Election debate. However one packages it, the NHS and other care provisions are in a profound mess, and there doesn’t appear to be any plans of substance to resolve the crisis being offered by any of the contending political parties.
This is lamentable because the NHS and healthcare has always been near the top of voter concerns, and this election is no exception. Whoever forms the next government will not only have to unpick and fund the repair of a ramshackle and uniquely complex suite of orgnisations, but they will have to confront fundamental questions about the future of the NHS, grounded in public demands and expectations that have changed immeasurably since the 5th July 1948, when the organisation was founded.
The Conservatives seem particularly reluctant to engage with this – having confined their funding plans to pretty much a continuation of existing manifesto commitments, including the building of new hospitals and a long-term strategy to increase staffing levels. The logic behind such a cautious approach is that promises made need to become promises delivered, and the Conservatives want to play this against Labour, who have a questionable history of making bold and expensive promises to transform and resuscitate the health service.
The weakness in the Conservative plan, especially in terms of staffing increases, is that this will involve an unbudgeted – but undoubtedly very substantial – extra cost to the service. After all, more nurses and doctors treating more patients reducing queues and waiting times is the best possible news, but this also incurs associated costs – such as extra medicines, more medical equipment, increased use of utilities and infrastructures to deal with increased staffing numbers.
According to the Tories, some of the funding for this will be achieved by cutting NHS management. It’s the easiest of sells to an electorate to say that administration and top level workers will be cut and more front line medical staff recruited, but this is one of the great myths of our NHS. Compared to other European countries, the NHS actually has fewer management staff, and many experts say this is a major contributor to the service’s problems. After all, with fewer managers, the service is less well-organised and administrative and managerial tasks are having to be performed by staff whose time would be far better employed treating patients. In this scenario, throwing more doctors and nurses into the NHS, with all the associated demands and costs they’ll need for support, would only worsen the inefficiencies and mismanagement of the system.
Over on the Labour side of the debate, the party is hanging its hopes on a soundbite promise to create ‘40,000 appointments per week’, which the party says will be achieved not by recruitment but by paying existing staff to work overtime at evenings and weekends. For a party that has been historically embedded in the fight for increasing rights and benefits for workers – and especially for our pitifully low paid health workers – this is certainly a strange proposal, and may just indicate how far to the Right that the party is lurching under Sir Keir Starmer.
For the average member of the public, and especially for anyone awaiting medical treatment, it’s not a comforting prospect that they might well end up being treated by already tired and stressed out medical staff working on an additional night time or weekend shift. Except of course Labour has already thought of that, because when you read the fine print the ‘40,000 appointments’ promise really only relates to outpatient appointments which are fairly routine, low cost examinations – so increasing these is a lot more achievable and less costly than increasing surgery rates, which is where the need really lies. It’s also worth mentioning that there were actually 145 million outpatient appointments in the NHS in 2023, so adding a further 40,000 isn’t exactly going to change the landscape.
Similarly to the Tories, Labour has also made various pledges about increasing medical equipment, such as scanners and diagnostic devices, but here too there’s a lack of understanding that it’s not just a case of wheeling an MRI system into a room. The physical equipment is the lowest cost outlay involved, and pales into insignificance against the unbudgeted cost of the extra staff needed to man the machines, handle the appointments and records and the routine running costs. All of this is also unbudgeted in the Labour promises.
To their credit the Liberal Democrats have actually formulated some useful ideas on NHS spending, including a review and overhaul of the salary system, a large increase in the number of GPs and some changes to the broader citizen taxation system to fund their proposals. But even these ideas are short of innovative, or anything like radical enough to make any meaningful impact on the service.
Promises such as we’ve heard in discussion, interviews and debates over recent weeks illustrate not only that the main political players have little understanding of, or interest in, getting to grips with our health service but they also seem to have precious little appreciation of just how much the British public appreciates the NHS and its founding principles.
In particular there seems to be in contemporary British politics a conviction that only tax savings and decreases can be sold to voters, when in fact all the evidence confirms that the public is quite happy to be taxed, and even have its taxation increased, to protect certain core services and societal principles. This is even the case when the personal financial consequences of such taxes have been explained.
In a major report – The Public’s Views on the Future of the NHS in England – published just last month by The Health Foundation, it was revealed that if taxes are to increase, participants wanted the extra revenue to be raised from a combination of taxes – though an additional tax earmarked for the NHS and increasing VAT were generally preferred over raising income tax.
“Concerns around the cost of living led participants to want assurance that any additional funding would be used effectively and for the burden to be shared across society, including with business and employers,” said the report.
This may sound ambitious, but it’s really only an echo of the very principles Eneurin Bevan promulgated when he announced the foundation of our National Health Service. After the landslide Labour victory in the 1945 General Election, Bevan was appointed Minister of Health. At that time the health service was in a similar mess to today, being controlled mainly at local level by councils with hugely variant attitudes and priorities. Bevan took a fresh look at the possibilities and the many power groups and decided that, instead of giving local authorities a lead role, all hospitals should be taken into public ownership.
On 5th July 1948 the NHS was born, much to the chagrin of many in the government, as Bevan was adamant that, where medical need existed, medical care should follow and budgets should be of secondary importance. This may seem like a rather utopian view of what is in many respects a huge commercial operation, but many in business today share Bevan’s take on how government’s should run such a complex business. Increasingly, a budget is recognised as a safeguard, a guide and an analysis of business activities, but should it inform the confines of day-to-day needs and activities? Many think not.
It might benefit those who are wanting to govern our country to consider the Bevan view – after all, the root of the NHS is the human person, whose needs must always come first. If we create a healthy and happy society, all else flows from that, including personal and national prosperity.
And that’s the essence of the problem with so many of the promises politicians have been making about the NHS – they’re focussed too heavily on soundbite promises and fiscal considerations, rather than prioritising the needs of the sick and vulnerable. The way forward needs to be focussed not on what the NHS can offer its patients, but rather on what patients need from the service. That might not sit well with the demands of budgetary planning, lucrative supply contracts or strategic political goals, but the next government will need to focus its efforts fully not on what is happening inside its hospital doors, but what is happening – and being asked for – by those beyond them.
Joseph Kelly is a Catholic writer and theologian