This article was originally published in The Times, 3/7/2023: https://www.thetimes.co.uk/article/sajid-javid-ailing-nhs-has-made-us-s…
Britons are sicker than in many other western countries as a “direct consequence” of the way the NHS is set up, a former health secretary has warned as he calls for a royal commission.
In an article for The Times, Sajid Javid says that both the Tories and Labour privately concede that the NHS is “unsustainable” and cannot cope with surging levels of demand despite record levels of funding.
Writing prior to the 75th anniversary of the NHS, he says that the health service is “frozen in time” and needs fundamental change as it swallows up ever more cash.
The “entire British state is on the verge of becoming a subsidiary of the NHS”, he argues, pointing out that the cost of healthcare has risen from 27 per cent of day-to-day public spending to 44 per cent since the turn of the century.
Despite the gravity of the challenge, the “politicisation of the NHS” has led to “short-term thinking” by both major political parties, constraining the debate about the future.
Javid calls for a “dispassionate and honest” assessment of the health service by a royal commission with cross-party support to look at models of care from other countries and report back within a year to provide a “collective mandate” for reform.
“No universal healthcare system is perfect, but when you compare health outcomes in the UK with similar countries, it is clear that for decades we have fallen short across successive governments,” he says.
“It’s a direct consequence of how the NHS is still structured. Since it was established in 1948, the world has significantly changed — yet much of the institution remains frozen in time.” Figures last week from the King’s Fund think tank highlighted that Britons consistently die earlier than people in comparable countries as a result of poor healthcare.
About 10,000 people a year die early who would be saved by French or Swedish levels of treatment, the figures suggest.
Javid says that demand for NHS services is surging because of Britain’s ageing population and increased access to new drugs and treatments, a problem exacerbated by the impact of the pandemic and rising waiting lists.
“Simply put, without fundamental change, the supply of healthcare will continue to be unable to keep up with surging demand.” He says that political parties cannot resolve the NHS’s issues because of short-term political thinking. “The politicisation of the NHS severely deters serious discussions about the problems it faces, let alone the potential solutions to them. It is also a barrier to serious reform and a driver of short-term thinking. This self-imposed caution extends to both voters and politicians, and it is letting patients and staff down.”
Britain’s ageing population is putting a strain on the health service, according to Javid
A royal commission, he argues, would help “break the deadlock” between the political parties. Royal commissions are public inquiries into major social issues of national importance and are often led by senior judges or other prominent figures. The last one was established in 1999 by Tony Blair into reform of the House of Lords.
Ministers have frequently tinkered with NHS structures but such reorganisations can become intensively controversial, with many Conservatives still scarred by the fallout from market-based reforms introduced a decade ago by Andrew Lansley. These have since been largely unwound by a less contentious reorganisation last year that had widespread political backing.
The Times Health Commission has been set up by this newspaper to consider the future of health and social care in England in the light of the pandemic, the growing pressure on budgets, the A&E crisis, rising waiting lists, health inequalities, obesity and the ageing population. The year-long commission will draw up recommendations for reform in ten areas and publish a final report in January.
Javid concludes: “Of course, as we approach that next general election, political parties will energetically debate the future of the NHS. But behind closed doors, they know the current set-up is unsustainable. Saying that publicly is much more difficult.
The cost of healthcare has risen from 27 per cent of day-to-day public spending to 44 per cent since the turn of the century
“Now is the time for the national interest to come to the fore with a collective mandate for reform. To make sure the NHS is here in another 75 years, we need a royal commission.” Javid does not set out his own preferred reforms, but has previously called for the introduction of charges for GP appointments and A&E visits, citing experience in Sweden, Germany and Ireland.
Earlier this year he wrote in The Times that the government needed to consider “extending the contributory principle” and asking the wealthy to pay more.
Javid is also understood to have praised Wes Streeting, the shadow health secretary, who has talked about phasing out the current system of GPs as independent contractors and for the NHS to employ family doctors directly.
Siva Anandaciva, of the King’s Fund, who wrote last week’s report, said while 10,000 was “the right ballpark of how many lives could be saved”, Javid was wrong to attribute this to a “structural flaw” in the NHS.
“Given the right conditions you get improvements,” he said. “It’s a management problem rather than a structural problem — if anything the structure is helping us and we’re not making the most of a nationalised health system. We have all the systems for a more stable planning environment [but] funding is incredibly lumpy and volatile, you have long periods of underinvestment followed by massive periods of catch-up.”
He cautioned against “expending a huge amount of political capital” on attempts to change the structure of the NHS. “If you want to expend political capital, spend it on fixing social care, not on having this debate,” he said.
No healthcare system is perfect, but we’ve fallen short for years
Tomorrow, a special service will be held in Westminster Abbey to mark the 75th birthday of the NHS (Sajid Javid writes). Attended by political leaders and others, those watching will be left in little doubt that alongside church and state, the NHS is seen as a central institution to British life.
I too have seen first hand the incredible dedication of its staff, both at a personal level and as health secretary. But as well as a celebration of the past, this must also be a moment for a serious conversation about the future.
No universal healthcare system is perfect, but when you compare health outcomes in the UK with similar countries, it is clear that for decades we have fallen short across successive governments.
It’s a direct consequence of how the NHS is still structured. Since it was established in 1948, the world has significantly changed — yet much of the institution remains frozen in time.
Added to this, demand is now surging because of an ageing population, changes in the burden of disease, and increased access to new drugs and treatments. The impact of the pandemic has made this even worse, as shown by significant waiting lists. The prime minister is absolutely right to target reductions in these, but strikes are making this even more challenging to achieve.
Simply put, without fundamental change, the supply of healthcare will continue to be unable to keep up with surging demand.
All of this is at a time of record funding for the NHS. In 2000, the health budget accounted for 27 per cent of day-to-day UK public spending; next year it will hit 44 per cent, larger than the GDP of Greece. The entire British state is on the verge of becoming a subsidiary of the NHS.
It is abundantly clear the status quo cannot continue. Unfortunately, part of the problem, and the reason why the NHS is under so much pressure, is that political debate about its future has become so constrained.
The politicisation of the NHS severely deters serious discussions about the problems it faces, let alone the potential solutions to them. It is also a barrier to serious reform and a driver of short-term thinking. This self-imposed caution extends to both voters and politicians, and it is letting patients and staff down.
To solve the challenges ahead, a dispassionate and honest assessment is required. One from an institution that is above the political fray, which has the legitimacy and expertise to detoxify the debate.
Nurses in London in 1947, the year before the NHS was created
Set up correctly, a royal commission can be the force to help break the current deadlock.
Their use has been limited over recent years, but with a clear remit, proper focus and cross-party support it can achieve important legitimacy. To be effective, it should report back within one year after the next general election for the government of the day to respond to.
It should assess what structural reforms are required and how we should be learning from other countries — including from their models of care. Importantly, it will depoliticise difficult issues and provide much needed long-term vision beyond press releases and election campaigning.
Of course, as we approach that next general election, political parties will energetically debate the future of the NHS. But behind closed doors, they know the current set-up is unsustainable. Saying that publicly is much more difficult.
Now is the time for the national interest to come to the fore with a collective mandate for reform. To make sure the NHS is here in another 75 years, we need a royal commission.
