Dissatisfaction with the NHS is at an all-time high and things are getting worse. Wes Streeting, the new health secretary, has made a good start, not least in appointing Lord Darzi of Denham to lead a productivity review — no one is better placed than the pioneering surgeon to advise on NHS improvements. But don’t think we can stop the boat from sinking by rearranging deckchairs more efficiently.
Each year since its inception the NHS has devoured more of every pound the country earns. And that’s not because it is centralised and state-controlled. Its administrative spending is among the lowest in the industrialised world (a third less than France and less than a quarter of the US). On the other hand private healthcare in Britain, far from being more efficient, is the fifth-most expensive in the world.
The fact is we’re just too stingy with the NHS. Germany spends almost 50 per cent more on health per citizen, France 20 per cent more, Australia, Sweden and Denmark 15 per cent more. The US spends 2.25 times more than we do.
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Around the world the costs of healthcare have been outstripping economic growth. Medical advances tend to be increasingly complex and expensive and the more we cure, the longer people live, and the more we need expensive treatments. The population is growing and consumer expectations are rising: we accept less suffering, pursue improvements in life expectancy and want more personal attention. We need better social care and we should focus on preventative measures but we can only do that by spending more or by diverting money from an already distressed delivery system. (And with obesity or smoking comes the challenge of imposing on personal autonomy and being derided as a nanny state.)
So what’s to be done? Most people still value the equitable approach on which the NHS was founded but our economy won’t grow fast enough and we show little willingness to pay much higher taxes. Even with the highest fiscal burden since 1945, the NHS is floundering and its physical estate is crumbling. The answer has to be refocusing what the NHS offers and charging more for those who can afford it.
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Yes, that violates a powerful ideal, but it aligns the NHS with the rest of the welfare state. And if, like me, you want the NHS to flourish, how else can we square the circle? Health costs will rise from 7 per cent of GDP today to about 10 per cent by the end of the decade. Even Darzi doesn’t have a magic wand.
Nick Ross was a non-executive director of Imperial College NHS Healthcare Trust 2016-2024 and a TV and radio presenter