If the NHS is a national religion, even the most devout believer might question their faith after a succession of scandals. Donna Ockenden’s five-year investigation set out yesterday in unsparing detail how expectant women were failed at the Shrewsbury and Telford Hospital NHS Trust. To that, can be added the scandals of Mid Staffordshire and Alder Hey Children’s Hospital.
Some of the criticisms at Shrewsbury echoed previous health debacles: patients weren’t listened to; whistleblowers were scared to speak out. This is clearly disturbing. But our love of the NHS shouldn’t blind us to its flaws: it can’t be heresy to blow the whistle.
A new poll suggests satisfaction with the NHS has plummeted, in stark contrast to the national display of affection for the health service at the peak of the pandemic, when we all turned out to clap for carers.
With deaths from Covid now a fraction of the January 2021 peak, public confidence in the health service has dropped to its lowest level for 25 years, according to the British Social Attitudes poll.
Saffron Cordery of NHS Providers identified staff shortages as the main issue. But can the health service really expect another cash injection any time soon?
Sajid Javid said a few weeks ago that the NHS would “spend its original 1948 budget, adjusted for inflation, once every month,” and pointed out the health budget was now bigger than the gross domestic product of Greece.
Day to day health spending will account for 44 per cent of all departmental investment by 2025. Admittedly, if you include capital spending (on one-off investment projects for example) and annually-managed expenditure (on things like pension payments), health spending falls to around 20 per cent.
But still, the government is clearly softening us up for a debate on what kind of health service we all want, and, crucially, how much we’re prepared to pay for it.
Labor will accuse the Conservatives of wanting to destroy the NHS. Some suggest that is indeed what some Tories may want. But others are interested in a mature debate, at a time when the public finances are under extraordinary pressure – and the tax burden is the highest since the 1940s.
If we want the NHS to cater for the full range of whizzy treatments as the population ages, are we prepared to pay higher taxes for it? Rishi Sunak’s £12bn National Insurance rise to fund health and social care was effectively halved after he decided to raise the threshold at which people start paying the tax. Even Labor wanted to scrap the £12bn tax rise, though it proposed clawing some of the money back with a windfall tax on North Sea oil and gas giants.
However, there is cross-party nervousness about loading ever-higher taxes on a population already weighed down by the cost of living.
And if health consumes an ever larger share of public spending, where does that leave schools – where money could be well spent on exhausted teachers and decaying buildings – or defence? The army is the smallest since 1714, just as Vladimir Putin threatens to plunge us into World War Three.
So, what we spend on the NHS (and how it’s spent) is clearly a matter for legitimate debate.
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As Professor Sir Chris Ham pointed out in an illuminating blog for The King’s Fund a few years ago, funding the NHS from general taxation has many advantages, not least that patients are confident about seeking medical help – no matter the cost.
But, as I have explained, other countries with enviable healthcare systems do it differently. The Germans use social insurance as the main way of paying for care. The French take out private insurance to cover part of the costs of theirs. In Australia, half the country uses tax breaks to help pay for private insurance.
This week, I went to the doctor about a dodgy-looking mole on my face. My GP asked if I minded waiting six weeks on the NHS, or if I wanted to use private health insurance via work. In the end I opted for the former and decided to wait. This is a choice very few have. And the idea of the NHS offering a basic service for all – while the rich get help paying their own way – feels wrong.
But tough choices on public spending are ahead. And however emotional we are about the health service, government ministers are already thinking with their heads – not their hearts.
Cathy Newman presents Channel 4 News at 7pm