Friday 7 December 2018 7:53 am

The NHS faces another winter crisis, but politicians continue to fail to learn the lessons of public sector failures


Kate Andrews is associate director at the Institute of Economic Affairs.

Kate Andrews is associate director at the Institute of Economic Affairs.

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On Thursday, the British Medical Association warned that NHS England is likely to be 10,000 beds short over the coming winter. The next few months are possibly going to be the “the worst on record”, as projections for A&E admissions are looking to increase by 100,000 this year alone.

It’s remarkable that the healthcare season is being dubbed a “winter crisis” before it’s even begun. But I suppose this only reinforces the point that the NHS exists in a perpetual state of crisis.

In January this year, 50,000 appointments were cancelled to provide more support to emergency services – hip replacements, cataract and knee surgeries all denied to patients.

It’s the same story every year. Healthcare, along with an array of other public services – from policing to Network Rail to social care – seem like they’re struggling for survival.

Some say that the answer is more money – higher taxes to create better-financed public services.

But this begs the question: what exactly are we paying for now?

According to the OECD, “Britain’s tax burden is catching up with the ‘big government’ countries of Europe”. The tax burden rose faster last year in the UK – 0.6 percentage points – compared to the average in the OECD – 0.2 percentage points.

The Taxpayers’ Alliance (TPA) also released similar figures this week, warning that the tax burden is at a “near 50-year high”, increasing to 34.6 per cent of GDP in 2018-19.

According to previous TPA research, the bottom 10 per cent of earners in Britain now pay 49.5 per cent of their income in tax, including income tax, VAT, and other duties – a burden which the Treasury plans to keep in place for the next half-decade.

If Britain’s tax burden is approaching the levels of its European counterparts, one would expect its services to be on an equal footing as well. But one glance at healthcare statistics, for example, makes it immediately apparent that the UK doesn’t come close to providing services that are on par with Germany, Switzerland, or even France.


The NHS illustrates that increased funding is often a secondary issue in the operation of public services. Reforming structures and making efficiency gains tend to matter most, and – as seen by our friends in Europe – can deliver beneficial outcomes for the patients they serve.

Sadly, these lessons have yet to be learned by this government, which has already committed an additional £20bn to the NHS by 2023 – roughly an annual 3.4 per cent increase in spending. More money will now be pouring into a failing system, which was designed for a population with millions fewer people relying on it.

What remains unclear is how it will be paid for, how much more taxpayers will have to hand over to avoid increasing the deficit, and whether or not it will make any difference to patient outcomes.

This year has been dominated by two policy issues: Brexit and the NHS. Arguably, both have been subjected to primarily political rhetoric, and denied proper policy debate.

But while we continue to discuss the potential outcomes of Brexit, the future of the NHS is agreed to be in crisis this winter, next winter, and seemingly forevermore.

What a joy it is, to be taxed more for the privilege of enduring failure.

City A.M.'s opinion pages are a place for thought-provoking views and debate. These views are not necessarily shared by City A.M.

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