The NHS is unsustainable in its current form, but the remedy is reform rather than more money alone. This was the conclusion of the landmark report by Simon Stevens, chief executive of NHS England, late last year. He argued that radical reform was needed to treat people quicker and prevent illness in the first place. The result would be not only healthier citizens but also much more efficient health spending.
He made the same point yesterday, when it was revealed that waiting times for accident and emergency patients are the highest for a decade. He emphasised that the pressure on A&E departments will never be solved until the NHS gives patients better alternatives, from stronger GP surgeries to telephone and online consultations.
The Stevens vision was the most positive statement from within the NHS for years. Nevertheless, it was a challenge to politicians to speak honestly of the need for change in the run-up to the election. At their best, the political parties do have radical plans to change the NHS for the better. Labour’s Andy Burnham speaks powerfully of his ambition to pull down the barriers between GPs, hospitals, mental health care and social care. The Prime Minister and the health secretary have each offered their support for Stevens’s vision.
But these arguments have been lost at the beginning of the General Election campaign. Instead of campaigning on their reform ideas, political parties are competing to give the NHS the biggest cheque. The Opposition has accused the Conservatives of proposing “a toxic mix of cuts and privatisation.” Labour has also argued that the health service would not survive another five years of failure “to give the NHS the cash it needs”. David Cameron, meanwhile, accuses the Opposition each Wednesday of wanting to lower the NHS budget, despite the fact that both parties have promised to ring-fence it. The arms race of NHS spending promises obscures what the service really needs.
In fact, better care must mean some cuts to the NHS budget. Earlier diagnosis and better prevention will mean fewer traditional hospitals and hospital doctors. That will save money because hospitals are the most expensive part of healthcare. Raising public concern about “cuts” undermines the service’s ability to make changes of this kind.
A campaign against “cuts” is not good policy. It may not even be good politics. The public is far more open-minded about the case for change than any campaign gives them credit for. In an opinion poll Reform commissioned from Populus last year, two thirds of the public agreed that the NHS needs reform more than it needs extra money. Two thirds also agreed that it doesn’t matter who provides their care, even if it’s a for-profit company, as long as they have fair access to it.
Health reform will be a battleground early in the next Parliament. Ministers will inevitably come into conflict with some of the representative groups of NHS workers. Being honest with the electorate ahead of the election is essential if politicians are to win the mandate for change they will need.