Voters won’t be thrilled if their NHS tax hike is wasted
Deciding whether to lock down a country in the event of a pandemic is one of the most difficult decisions a prime minister has to make. But in many ways, an equally difficult – albeit less immediate – decision needs to be made regarding the long-term future of the NHS. No national institution is more precious and nothing matters more to us individually than our health. But just like with a pandemic, there are tradeoffs that cannot be avoided.
As many Telegraph readers, I was uncomfortable when the government increased national insurance by 1.25% as part of a new health and care tax. I have always believed that a competitive, low-tax economy is the best way for our country to be strong and prosperous – as well as providing reliable long-term funding for the NHS. Indeed, the only time that such funding has been cut in real terms was under a Labor government that lost control of our national finances and had to turn to the IMF.
But this time the government was right. With the aging of the population and advances in medicine, we are all going to pay more for our health. In America this means higher insurance premiums, in Germany and Holland higher social insurance premiums and in Great Britain and New Zealand more taxes. We will likely see less of an increase because the NHS is using its wholesale purchasing power to drive lower drug prices than other countries.
But if taxes are not spent wisely, governments pay a heavy price. Rather than being praised for cutting wait times, Tony Blair found himself constantly criticized for NHS waste. How can this Conservative government avoid the same fate and put the NHS on a long-term sustainable basis?
The first thing is to be clear where we are going: we must explicitly aim for the NHS to provide the safest and highest quality care available anywhere. We have to be honest, while sometimes it does, sometimes, even despite the superhuman efforts of its frontline staff, it doesn’t. Having learned many lessons from my time as a Secretary of Health, here are the three biggest ways to change that. None of them involve getting into a debate about how we fund the NHS, which would be both divisive and distracting – but taken together they will allow us to deliver the kind of care health sought by supporters and detractors of the NHS.
First, we need to determine why we have never trained the number of doctors and nurses that we really need. It takes seven years to train a doctor, but which chancellor or health secretary is going to prioritize the number of doctors we need in a decade? I actually did, with big increases in 2016, but due to the delays, no additional doctors have joined the front line yet.
The result is that, according to the Royal Colleges, we are now short of 500 obstetricians, 1,400 anesthetists, 1,900 radiologists, 2,000 midwives, 2,000 emergency care consultants and 2,500 general practitioners, with nearly 100,000 vacancies in the NHS. Yes, it costs more to train additional doctors, but it costs even more not to train them because then we hire expensive locum doctors and agency nurses. We should amend the health and care bill so that there are independent public forecasts of the numbers we should form. I hope the government accepts an amendment from the House of Lords to do this.
Second, we must redouble our efforts for the safety and quality of care. History teaches us that huge delays like the one we have now can lead to a culture of targets in which numbers outnumber people. The national goals are well intentioned but require hospital managers to devote their main effort to managing their own bosses rather than focusing on patients. No other country runs its hospitals this way for the very simple reason that it doesn’t work. Imagine if we gave the secretary of education a target for the number of crosses to level A? We should let the CQC do the same job as Ofsted in the NHS, as it does very effectively, without the bureaucratic red tape of national goals.
Finally, when we got to the workforce shortages, we should bring back what a lot of people thought was the best thing about the NHS: having your own family doctor. A recent study in Norway found that people who had the same doctor for many years were 30% less likely to need after-hours care, 30% less likely to go to the hospital and 25% less likely to die. The best care comes from doctors who know their patients, something that was scrapped with the changes to the GP contract two decades ago.
I’m not suggesting we go back to the days when GPs were on call 24/7, but every GP I’ve spoken to says their job was much more rewarding when they had their own patient lists. Of course, we will need more GPs than we currently have to do it, but if the outcome is better, safer care, this is what we should be doing. My select committee will examine this issue in detail in the new year.
Money matters, but without reform it is wasted, as countless governments have discovered. Let us show that this government is capable of both.
Jeremy Hunt MP is Chairman of the Health Select Committee and former Secretary of Health