There is a demographic steam train hurtling down the NHS tracks and so the recommendations of The Times’ Health Commission are to be welcomed.
There is little here with which one could argue and, indeed, many of these recommendations reflect those Radix Big Tent has set out in its own recent proposals, A New Social Contract for the NHS and our The Best NHS? series.
And yet there is something missing.
Political debate around the future of the NHS is paralysed by the unwillingness of politicians to confront the fact that these will never be enough money to meet the growing demands for health care, driven by an ageing population, increased life expectancy and improvements in treatments.
Calls for investment in health promotion and an emergency plan to tackle the waiting list backlog are sensible – but they can’t alone bridge the gap between what the public expects and what society can afford.
To make a real difference we must stop pretending that the NHS is free at the point of delivery. We charge for lots of services (for example, in much of the country free dentistry is a myth).
And even those services that appear ‘free’ (sic) have a cost, whether or not it is visible, as it means there’s less money in the overall pot to fund other things – such as housing and education – which may in turn have a bigger overall impact on health and wellbeing. So if we stop pretending healthcare is free, then we can prioritise what we charge extra for.
We must stop pretending that access to healthcare isn’t rationed. Then we can ask if rationing by waiting list is the fairest and more efficient way to do it? Instead, we might wish to consider the patient’s long term prognosis, inclination for self-care and ability to contribute, to pay for the treatment of those that cannot afford it.
The only way to really transform healthcare in Britain is to fund it differently, as almost every other developed country does, whether through mandatory health insurance, new charges or greater use of privately purchased components.
Because such suggestions are currently political untenable, we have long recommended a Royal Commission to build consensus for reform. We need to take the debate out of the political sphere. In the absence of a Royal Commission, The Times’ own initiative offered the opportunity to begin that task.
Constructive as its recommendations are, therefore, in so far as they go, this is a missed opportunity.
We instead call for more radical structural reform, and hope the new government has the courage to consider it, before change is imposed on the NHS by the ultimate inevitable collapse of the current model.