Are we brave enough to reform a system in crisis?

Published by The Mail on Sunday (15th November, 2015)

The National Health Service is in a mess – and we are reaching the crunch point for its survival in the shape we have known for almost seven decades.

It has, of course, been in near-permanent crisis since the day it was born. But the costs are rising too fast in our aging, growing and fattening society; demand is outstripping the supply of care available from its overloaded workforce.

This simple fact lies behind most of the problems that flare into headlines, such as the threatened strike by junior doctors over rightful provision of improved seven-day care.

Today’s  poll shows patients are ready to consider paying at the point of use. This is a symbolic moment  – yet even such measures would raise a fraction of the sums needed to salvage the service.

Since the turn of the century, spending on the NHS has more than doubled. It has been boosted even amid austerity. Yet waiting lists have hit seven-year highs, A&E teeters on the brink of chaos, and most hospitals are running deficits.

Britain needs to start facing up to harsh facts. The NHS is not the envy of the world. It has abysmal cancer survival rates, poor stroke survival and the worst under-five mortality levels in Western Europe.

One recent report found 9,000 people die needlessly each year because the service is worse than its European rivals. Another study comparing healthcare in 34 countries found ‘really disturbing’ levels of care, falling below Turkey, Poland and Portugal in many areas.

There are efficiency savings to be found, from inept procurement to over-paid managers. But stripping out £22bn a year in costs, as current plans demand, is a pipe dream.

Britain needs to answer a fundamental question. Are we so devoted to our delusions over the NHS that we will stick with an underfunded and overburdened system that kills patients through rationing and reduced quality?

Even if the answer is yes, there still need to be hefty tax increases or huge cuts to other public services to sustain services – probably combined with new charges that fall largely on middle-class and middle-aged patients, plus wider use of personalised budgets.

The alternative is to follow the rest of Europe by moving towards a social insurance model.

One thing is certain: the point is fast approaching when we can no longer duck painful decisions over our sickly health service.

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