Does the government want to tackle the NHS crisis or just evade blame for it?
It was only towards the end that we got a glimpse of the Chancellor’s true attitude towards the NHS. He went into a passage setting out his economic philosophy and asked the House of Commons: “Now we have a choice. Do we want to live in a country where the answer to every question is what will the government do about it?”
If you had only heard the first half of Rishi Sunak’s household speech, you’d be forgiven to believe that he continues with Gordon Brown-style spending for the NHS. Health care spending has risen by £ 44 billion to over £ 177 billion, the health capital budget “the largest since 2010” and a list of major new hospitals and operating rooms to help the health sector cope with its huge treatment backlog. It all sounded very generous.
He added that while he has “taken some corrective action to fund the NHS and get our debt under control” he wants to cut taxes. In short, this is not a government that throws money at every problem. It’s time everyone else got in shape too. It’s as if Sunak took inspiration from one of his beloved peloton spinning classes and hopes that if he shouts enough motivational quotes at public services and corporations, all will be well.
This is in line with the general sentiment in government towards healthcare. Ministers agree that more money is needed to cover the backlog. But they will not continue to throw money into the service. The NHS needs to be modernized and made more efficient: this is not a problem that the government can solve with money alone.
That’s why a retired general, Sir Gordon Messenger, is conducting a review of the service’s administration. That’s also why Health Secretary Sajid Javid has set up what he calls a “Health Delivery Unit” at his ministry, designed not only to ensure the backlog is cleared, but that healthcare doesn’t just show off the extra money with little too subsumed Therefore.
The creation of this entity inevitably gave support to the NHS as its senior figures felt the body’s full name was NHS England and NHS Improvement because the health service should do its own delivery work. It’s rumored that Javid’s team will focus more on reshaping the waiting lists so people who are clinically unready for treatment – because they need to lose weight, for example – are not included in the numbers.
In turn, Conservatives argue that health care never likes being told it needs to become more efficient, just as individuals dislike being told they are unfit. For example, every tenth foundation is still largely paper-based. Messenger will find many other startling anachronisms in a healthcare service that British politicians have been hailed as ‘the world’s best’. But Sunak’s peloton policy won’t make the NHS the true envy of the world either. His budget was missing something as essential to healthcare as a fancy bike is to a fitness enthusiast.
There was nothing about the NHS workforce. Staff shortages have long been a problem and, as I’ve written in previous columns, is likely to be exacerbated by burnout and trauma in the pandemic. The ‘Red Book’, which details the budget, suggests that ‘this will be supported by funding to continue building a larger and better educated NHS workforce’. But there is no plan how the workforce should grow in the next few years. Worse, the HR authority, Health Education England, is expected to see a real cut in its funding. I understand there is still some argument over whether the Department for Health and Social Care or the NHS will spend extra money to fill the gap. It is a serious omission that this was not rectified in time for the budget.
If the NHS doesn’t have the doctors and nurses to deliver the surgeries and medicines needed, can the NHS really clear the treatment backlog and prevent health outcomes from falling? Or is talk of the importance of efficiency less about the need for healthcare to work better and more about blaming it when it fails because it was designed to do so?
That sounds like the kind of conspiracy theory being espoused by someone who is convinced the Tories are on the brink of some kind of darkly evil US-style privatization of the service. They’re not: Any thinking Conservative recognizes that debating the principles of the NHS is pointless. Also, one conspiracy theory credits the Tories with some kind of sophisticated long-term health plan. What happens is exactly the opposite.
Isabel Hardman is Associate Editor of The Spectator magazine. She writes a monthly health policy column for I