A &E won’t kiss it better,” say the bracing but necessary advertisements on London buses. Unfortunately, A&E won’t necessarily save your life either, not for want of expertise or compassion but because of a fundamental mismatch between supply and demand that afflicts the entire NHS.
The service is in the grip of a four-pronged vice of ageing patients, ever-costlier treatments, rising expectations and acute pressure on budgets. Everyone who debates health policy in parliament knows this. There is surprisingly little disagreement on the basic priorities for improving care, from better co-ordination between hospitals and care homes to the need for more resources. What no main party leader dares discuss is where those resources must be found.
The business model of the NHS is strained beyond repair. At a time when half of us will develop cancer sometime in our lives and cutting-edge drugs can cost £50,000 per patient a year, a world-class health service free at the point of need, funded entirely from direct taxation, is not sustainable. If the next government is serious about preserving the NHS it must level with voters about the need to find new ways to fund it. The approach need not amount to privatisation. However, it will have to borrow from the best systems in other countries. Most deliver better outcomes, especially in the treatment of serious illness. All are insurance-based, with charges in some cases for hospital stays and doctors’ visits. As a result they are better able to keep up with demand. The NHS is a wheezing laggard by comparison.
Bleak new statistics from the nation’s ambulance services illustrate the point. Responses to freedom of information requests by The Times show that the number of patients with life-threatening conditions forced to wait more than an hour in an ambulance before A&E treatment doubled last year. The number who died before even being admitted to an A&E department tripled.
Ambulance queues caused by unnecessary callouts are one reason for this trend. Others include ill-advised referrals by the 111 health line, overstretched A&E staff, inadequate or non-existent out of hours care at GP surgeries and weekend bottlenecks when elderly patients with chronic conditions end up at accident and emergency for want of timely residential care.
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Labour would have voters believe the NHS is on life-support and about to be sold off for scrap to the highest bidder. In fact sensible research by the King’s Fund think-tank has given the lie to the privatisation myth. Barely 5 per cent of NHS services have been outsourced to the private sector. Nor is money a panacea, yet there is no doubt that more of it is needed. Even Labour’s campaign promise of £2.5 billion a year more than the Tories falls far short of the extra £8 billion a year that Simon Stevens, the current NHS chief executive, says is needed.
Without funding on this scale the service will face a £30 billion shortfall by the end of the decade. To bridge it, brave thinking that shatters old taboos is needed. As Mr Stephens has written in this newspaper, the health service cannot be a hostage to its history. But that is what it will be unless politicians find the courage to stop worshipping the service and rethink it for the modern age. For five years David Cameron has himself been hostage to his three-letter health policy (“NHS”). Labour is so deeply in thrall to the status quo that this week it forced the Commons health select committee to scrap an NHS report for being too supportive of the coalition.
The health service consumes less as a share of GDP than comparable systems abroad, but it ranks poorly on keeping people alive, it is over-politicised and it is heading for insolvency. The prime minister who works out how to pay for it will go down in history as the one who saved it.