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A report this week by the Commons Health and Social Care Committee revealed what most of us had spotted rather a long time ago. The NHS is in big trouble. When the Labour government of 1948 set up a national health service the promise was that would it would be comprehensive, high quality and free at the point of delivery. Has the time come when that last promise must be reviewed? Must we accept that some form of privatised NHS is an inevitability?

On one thing the experts agree. The NHS is not delivering what was promised all those years ago. Hospital waiting lists are getting longer. Some 6.6 million people are waiting for hospital treatment in England alone. Another 1.6 million are waiting for mental health treatment. Ambulance waiting times are so high that in some areas the NHS no longer functions even as an emergency service. Millions of people are finding it difficult, if not impossible, to get an appointment with their GP. Doctors and nurses are stretched to breaking point. Unless something pretty drastic is done, say the experts, things can only get worse. That’s partly because ours is an ageing society and old people inevitably make the greatest demands on health and care services. One carer in three quit last year and the number of full-time GPs has fallen by more than 700 since 2019, with the majority now only working part-time.

A report this week by the Commons Health and Social Care Committee revealed that we need 12,000 more doctors and more than 50,000 nurses and midwives. By the start of the 2030s that might have rocketed to an additional 475,000 extra skilled staff such as doctors and nurses and another 490,000 lower-paid staff such as carers. Another survey for the NHS suggests that only one in four family doctors is now working full time – at least 37.5 hours a week. That’s the lowest proportion in five years. Most work three days a week or fewer. A Health Foundation forecast showed that a quarter o GP posts could be vacant in England in the next ten years.

Professor Martin Marshall, chairman of the Royal College o GPs, says they are ‘overstretched’. He said: ‘An exhausted GP is not able to practise safely or deliver the high quality care and service they are trained to deliver for patients.’

So let’s look at the financial balance sheet. The highly respected Institute for Fiscal Studies has calculated that within the next two years healthcare may account for up to 44 per cent of day-to-day government spending. That is a truly sobering thought when we consider that day to to day spending includes schools, transport, police, the military etc etc. Very soon, the IFS predicts, the NHS will also have swallowed up the funds raised by the new health and social care levy which is meant to raise £12 billion a year.

But the defenders of the NHS say let’s not be so gloomy. Let’s look at what we get from the NHS or, more specifically, its hard-working and self-sacrificing doctors and nurses and cleaners. Weren’t we standing on our doorsteps and applauding them only a couple of years ago?

True, say the sceptics, but the problem lies not with doctors and nurses but their bosses: the bureaucrats and administrators who pay themselves vast amounts of money in return for creating a system that is, at best, pretty clunky and, at worst, simply unfit for purpose. They point to the vast amounts of cash that have been wasted on projects like a state-of-the-art computer system a few years back which might have been fine if it had worked. But it didn’t. The billions spent were, quite simply, wasted. They also claim that too many top health officials have their priorities wrong. They’re more concerned, they say, with appeasing gender activists who demand, for instance, new

draft guidelines from the Royal College of Obstetricians and Gynaecologists on how to support transgender men in "chestfeeding" babies.

Even the most fervent defenders of the NHS will concede that some of that may be true but, they point out, you might say the same of any organisation as massive and complex as the NHS. And anyway, if things are as bad as the sceptics claim how come the rest of the world envies our NHS? To which the sceptics say: if they really do envy us how come they haven’t copied us? There is not a country in the world, they point out, which has the equivalent of our state-controlled and state-financed system.

They also say that, rather than buy into the comforting myth, we should look at the hard reality of statistics, which tell us that Britain ranks low among advanced industrial economies in terms of life expectancy, cancer treatment and survival from strokes and heart attacks. The OECD says the UK saw a fall in life expectancy of 0.2 years between 2010 and 2020. Comparable countries saw an increase of 0.8 years. In 2018, 75 out of every 100,000 Britons died of a treatable disease, putting the UK in 17th place out of 18. Since 2010, by this measure, the UK has never risen above 15th.

So if we have a crisis, what solutions are being offered by Liz Truss and Rishi Sunack, one of whom will have to deal with in pretty short order? Neither has gone into any great detail but Mr Sunak has proposed increasing the number of "diagnostic hubs" that are dealing with the NHS backlog from 160 to 200 and shortening the target for eliminating one-year waits for treatment. Ms Truss promises there will be more hospitals and expanded GP services.

But again, the sceptics ask: where will the money come from? Which takes us back to the skeleton that has been lurking in the cupboard since the NHS was little more than a dream in post-war Britain. Privatisation.

It was regarded then, and is regarded now, as the terror that dare not speak its name – at least not if you’re a politician who wants to hold on to his seat at the next election. Privatisation is a dirty word. Which is odd, in one sense, given that it exists in one form or another in every industrialised country on the planet and even in this country. Our dental service is, in almost every case, provided by private practitioners. Sceptics will say: ‘Exactly! And when did you last try getting an appointment without having to pay for it?’

I suspect we all know somebody who has, in one form or another, benefitted from private medicine. I have three friends, all of whom live in different parts of the country. All have been in great pain for some years and needed a new hip. One decided to go private. It cost her almost £12,000. Another managed to get it done on the NHS and the third was told he’d have to wait for at least a year but might be able to get it done sooner in a private hospital with the NHS footing the bill. He’s still waiting.

Those prepared to die in a ditch in defence of our beloved NHS point to countries like the United States. The health service is wonderful – but only if you have the cash to pay for it. I’ve experienced it for myself and my children. But if you can’t afford the insurance premiums you are in trouble. There are, of course, many different systems which involve some element of private input. In Canada, for instance, the state pays for the health care but it is provided by the private sector.

PROFESSOR Stephen Smith, the former CEO of Imperial College Healthcare NHS Trust and Dean of Medicine, says some form of private provision is inevitable because it is ‘an institution on its last legs.’ He argues for something that is ‘not a US-style private health system but European social insurance’. Under this scheme, he wrote in the Mail, ‘everyone is obliged to pay into a health insurance plan from a choice of insurers. The government defines the mandatory minimum package and subsidises those on low incomes or with excessive health risks. This system provides patients

with accountability, choice and leverage. Bureaucracy is kept to the minimum. Health service staff are independent of government control and interference.’

Professor Smith acknowledges that such fundamental changes would ‘pose huge practical challenges’ but claims that with ‘astronomical sums being poured into the NHS black hole, increasingly disrupting Britain's economic and political priorities and producing worse health outcomes than other countries... the status quo is simply no longer an option.’

The Guardian has traditionally argued fiercely against privatisation. Its health editor Andrew Gregory, says it has been ‘accelerated by Tory policies’ over the last decade’ and he quotes analysis by Oxford University, published in The Lancet, which concludes that it has corresponded with a decline in quality and ‘significantly increased’ rates of death from treatable causes.

Its authors speculate that the higher mortality rates in the NHS might be due to private companies ‘delivering worse-quality care, resulting in more health complications and deaths’, or because greater competition for contracts may result in for-profit providers prioritising shorter waiting times “at the expense of quality of care”.

Where do you stand in this crucially important debate? Clearly most of us don’t have the wherewithal to analyse the statistics and evaluate all the possible alternatives, but are you broadly sympathetic or broadly hostile to the principle of greater privatisation of the NHS? An easier question might be: does your own experience of the health service suggest that there is something fundamentally wrong or are your broadly satisfied? And would you prefer to pay for your health care directly, perhaps through an insurance scheme, rather than through your taxes?

Do let us know.

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