Why is Wes Streeting launching a report that argues the NHS doesn’t need to change its funding model? The Health Secretary gave a speech this morning at the IPPR to mark a new analysis of whether social insurance systems automatically lead to better health outcomes. The answer, according to the report’s authors at least, is that they don’t and that overhauling the funding source of the NHS would not solve its most serious problems.
Its analysis ‘confirms the finding of other studies: no group of health systems systematically outperforms another’, but it is not exactly complimentary of the NHS itself. It points out that the health service ‘performs poorly across too many indicators of care quality, access and overall, including when compared with other tax-funded systems’. This underperformance is due to ‘long-term undercapitalisation, a short-termist approach to efficiency in which the system has been run at unsustainable pressure, and underinvestment in administrative capacity that enables effective delivery. Changing the funding model is highly unlikely to resolve these challenges and would be a distraction from the solutions that might.’
That happens to be a very helpful conclusion for Streeting, who is now arguing that voting for populist parties such as Reform and Plaid Cymru would put the NHS under threat, and that the health service is a ‘key battleground’ in the local elections. He wants to worry voters that Reform would change the way the NHS is funded – and to imply that Nigel Farage’s party would also change the way it is accessed too.
That’s not to say that the IPPR report isn’t useful or interesting on its own terms, or that the discussion about funding isn’t a timely one. The report acknowledges in its introduction that the health service ‘is in serious trouble’, that more than half of British adults are dissatisfied with how it runs, that staff feel undervalued and exhausted and that key performance targets haven’t been met for more than a decade. The health service is at a point of existential crisis where Brits are starting to wonder whether it can be saved for the future – especially those who have ended up paying twice for their own healthcare: once through general taxation and again having chosen to scrape together the funds for timely private elective treatment rather than spend a year on a waiting list. There has long been an awareness among Labour politicians that consent for the NHS will evaporate when voters feel that they cannot rely on it but are still paying for it. Back at the turn of the millennium, New Labour feared that tipping point was close, and poured huge resources into reforming the health service in order to save it. Now, we are at that tipping point again – and if by the next election voters don’t feel that this Labour government is at least turning around the NHS, then they will start to question whether anyone possibly can, or whether it is time for a new model.
While the Labour party has long defended the NHS by accusing its critics of wanting to scrap its funding model and move to something closer to the US healthcare system, the fact that the IPPR is examining how other countries across the world fund care shows that the debate has recently become more nuanced – and more dangerous to the NHS itself. It is easy to frighten voters with stories of the gaps in American care, much less so when they remember that other countries also have functioning healthcare systems with better outcomes.
There is a policy challenge here for Streeting, though: if the answer to Britain’s healthcare problems isn’t tearing up the NHS and starting with something new, then there are still those serious issues around capital funding, short-termism and administration which are not easy to solve and which don’t tend to make for easy headlines (unlike the idea of sending ‘crack teams’ into hospitals, which was trailed in the weekend papers). In Streeting’s speech, he listed the ways in which the Tories and others had opposed the NHS back in the 1940s, and then quoted Conservative, Reform and other politicians who have critiqued the funding model today. He listed the things Labour had achieved on the NHS since coming to office in terms of recruitment, waiting lists and dealing with industrial action. He also insisted ‘I have been more honest about the failures of the NHS than any of my predecessors’, and that ‘no-one defends the status quo’. But the ‘transformation’ that he claims is happening is still not going to address the deep problems that the IPPR pointed to, and Streeting wasn’t able to answer them today either.
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