With record waiting lists, thousands of excess deaths, and nurses striking for the first time, the UK’s National Health Service (NHS) is once again buckling under pressure, stirring up debate on how to fix the system.
In England, the Conservative government is scrambling to settle pay disputes and free up hospital beds, while Labour leader Sir Keir Starmer, positioning himself to be the next prime minister minister, backed plans to allow self-referral instead of waiting for GP appointments, and absorbing GP services into the nationally owned NHS.
Jenkins: Ruling Party Not the Problem
In Westminster, Labour criticised successsive Conservative governments for a decade of underfunding and mismanaging NHS England, citing the doubling of hospital waiting lists during the time before COVID-19 hit.
But Jamie Jenkins, former head of the labour market and health analysis team at the Office for National Statistics, said the latest figures do not support the assumption that one party is better than another in running the system.
The NHS is separately run in Britain under the UK’s devolution rules, by the ruling Conservatives in England, the Scottish National Party in Scotland, and Labour in Wales.
“If you look at it politically ... all three health systems are struggling,” Jenkins told The Epoch Times.
“For example, Wales, if you look at the percentage of people who are on waiting lists for over a year, that’s over 20 percent. This is a lot lower—closer to 5 percent—in England,” he said, adding that the data show “regardless of which party” is running the NHS, “it’s clearly not working at the moment.”
Widdecombe: NHS ‘Never Designed to Cope’ With Current Demand
Ann Widdecombe, former shadow health secretary, told The Epoch Times she strongly believes in having a national health service that can provide free health care to those in need, but argued the original arrangement, which is a service free to all at the point of reception, is only the “vehicle” chosen to deliver the vision, but not the vision itself.The current funding model, she said, has created a “three-tier” system, in which some can either get NHS treatment or go private, but the poorest people who get stuck on a waiting list or lose out in a “postcode lottery” can’t get treatment.
The former Conservative minister and Brexit Party MEP said those who are not treated are the very people for whom the NHS was created, and that “the vehicle has completely broken down to such an extent we’ve now abandoned the vision.”
In Widdecombe’s view, the NHS was “well-designed” when Bevan created it, but “never designed to last into a very changing future,” in which demand for health care has been driven “almost towards infinity” by the improvements in medical and surgical science and “the enormous rise in longevity.”
Both have increased demand on a system that was “predicated on falling demand,” she said, adding that Bevan also didn’t anticipate the service would eventually became mostly funded by general taxation rather than National Insurance.
Widdecombe argued it “just isn’t possible” to fund the NHS enough to solve all the problems, saying money thrown at the service in the past has lasted only “five minutes.”
She called for a redesign of the NHS, saying the UK needs to come together to discuss “if we were starting now, knowing what we know now, how would we have designed a national health service,” and how to “get there from here.”
Funding and Operations
Successive UK governments have increased their spending on the NHS since its inception in 1948. In 2018/19, around £153 billion ($187 billion) was spent on the service, more than 13 times the spending during its first full year of operation in real terms, which was £11.4 billion ($14 billion) in 2018/2019’s money.Government spending on the NHS as a percentage of GDP grew from 2.9 percent in 1958/59 to 7.1 percent in 2018/19. It last peaked during Labour’s last year in government at 7.5 percent.
Private companies have been contracted under the NHS for over a decade, accounting for about 7.2 percent of total revenue budget in 2019/20.
With the possible exception of the likes of Cuba and North Korea, experts have said that the NHS is the only nationally owned and run health care service in the world. Other nations have different universal health care arrangements, but these are run through nationally funded medical insurance schemes or other models that involve non-state organizations.
To enlarge the “funding cake” for health care, Widdecombe said “people who are able to pay something should pay something” when using the NHS.
Jenkins suggested the NHS can consider paying for “life-threatening” conditions and charging users for other things.
He said the proposal would increase funding and help foster a “customer-business relationship.” Asked whether the plan would drive down demand, Jenkins said “potentially it could,” adding that promoting healthier lifestyles may also reduce the burden on the NHS.
Jenkins criticised successive governments’ “short-termism,” saying it takes long-term planning to increase hospital beds, expand the workforce, and consider how pension and social care should be funded.
Asked whether it would be better if services are not centrally run, he said the service may not be as good unless a private organisation can “eke out deficiencies” and balance quality and profit, but he’s open to learning from other countries’ experiences as the current model is “clearly not working.”
If “the same amount of money goes in ... and it’s done more efficiently with the money that you’ve got and patient outcomes are better, then obviously it’s a win-win for everybody,” he said.
Widdecombe said the private sector should be used “a lot more” than it has been, arguing waiting lists wouldn’t be as long if routine cases were sent to the private sector during the COVID-19 pandemic.
Political Hurdles
The NHS, which featured in the opening ceremony at the London 2012 Olympics, has often been described as a “national religion.”Conservative reforms of the NHS have invariably attracted suspicions of “creeping privatisation.”
“The difficulty there is that politics come back into it and as soon as you mention review of the NHS, some folks start getting panicky and use it against each other, which is why it’s difficult to get any change,” Jenkins said.
Asked why people fear changes to the health service, Jenkins said part of it stems from the belief that “private companies shouldn’t be profiting out of health care” and that a profit-driven model may result in a sacrifice of quality.
But Widdecombe contended that there has always been “a willingness to debate how we go forward” on the public’s part, and it’s the political parties that lacked “political courage,” saying, “the Tories are terrified that everybody will say they’re privatising it and the Labour Party is in hock to the unions.”
As to whether reforming the NHS would harm doctors and nurses, Widdecombe said the unions “always oppose change.”
The doctors, who are “the keenest defendants” of the NHS, were “the biggest opposition” to the service’s creation because they “thought it was going to be a disaster,” she said, adding that GPs used to oppose the introduction of former Health Secretary Kenneth Clarke’s GP fundholding scheme, before opposing its abolition.
