Reader TTS

While Conservatives will be looking forward to Christmas in a mood of relief, they will be conscious that the campaign was hard fought. Labour found that, as with previous elections, the NHS

provided them with electoral “traction”. Voters were warned that the only way to “save” the NHS was to vote Labour, while the Conservatives were threatening to “privatise it.” The prospect

of a free trade deal with the US gave a fresh angle to this traditional Labour theme. We were told that the NHS would be “sold to Donald Trump”. Pretty far-fetched. For a start, the NHS runs

at a loss of £134 billion a year. I’m not sure that it would make for an especially shrewd investment. But even those who didn’t really believe these claims might have sympathised with the

message that the NHS was struggling due to “Tory austerity”. The photograph of four-year-old Jack Williment-Barr lying on a pile of coats while awaiting treatment for suspected pneumonia at

Leeds General Infirmary had a big impact just before Polling Day. It was part of a theme that had begun even before the election was called. In September, Omar Salem confronted Boris Johnson

at Whipps Cross University Hospital in north-east London. Salem explained that his new-born daughter was “gravely ill”. He complained that “there are not enough people on this ward, there

are not enough doctors, there’s not enough nurses, it’s not well organised enough”. Such cases resonate with the public. Tory politicians, going back to Margaret Thatcher, respond by

pointing out that, under the Tories spending on the NHS has gone up. While the claims of billions of extra spending are true, so are the well-publicised deficiencies. Any notion that

spending a few extra billion will be transformational is naive. Theodore Dalrymple, a retired prison doctor and psychiatrist, suggests that our pride in the NHS may be misguided: “When the

NHS was introduced, life expectancy in France was two and a half years lower than in Britain. It is now a year higher. The life expectancy in Spain was six years lower in 1948 than in

Britain, and is now nearly two years higher. In other words, in both these countries life expectancy has advanced more than in Britain during the existence of the NHS, in Spain’s case by as

much as eight years. Nor did the rise in life expectancy in Britain accelerate after the establishment of the NHS.” This leaves us with a paradox. The public are both proud of the NHS and

dismayed that it is in a state of “crisis”. The way to improve its performance is by reform. The dilemma is that this would invite public suspicion and angry demonstrations. Any reforms

would be denounced by Labour as “privatisation”. However, the government has a big majority and five years to see its changes delivered. Certainly it must deliver on its promises of more

doctors and nurses and new hospitals. In the coming months, it will also be able to show that a trade deal can be agreed with the US that does not undermine the NHS. From that position of

strength, the government should make clear that the NHS is far from perfect. That while free universal health care must be maintained, it needs to make clearer that there already is a

significant role for the private sector inside and outside the NHS. Private health care saves lives. Where businesses provide health insurance for their employees and their families this is

to be welcomed. Choice and competition tends to ensure that care is of a high standard. It eases the burden on the NHS, especially as much of it is preventative. As demand on the NHS

increases, this becomes even more important. So there should be bold changes in the tax system — on both corporate and personal taxation — to make health insurance much more affordable for

those on average incomes. The NHS itself also spends money on independent health providers — about £9 billion a year. Sometimes it is because routine operations such as cataract surgery,

might be of lower cost to the taxpayer if the NHS outsources the work. Or it could be that some extra capacity is needed, perhaps some beds in a private hospital, during an exceptional

period of demand. I suspect that most patients are pleased to get the care they need in a timely manner, without being presented with a bill, even if the NHS arranges for another provider.

Where the NHS should go further, is making these arrangements a matter of the legal right of the patient rather than a matter of the convenience of NHS managers. During the election

campaign, Jon Ashworth, the Shadow Health Secretary declared: “Cancer waiting times are the worst on record. Last year over 34,000 people with cancer waited beyond two months for treatment.”

A powerful indictment. Should we not give those people a legal right to that treatment within the deadline? If the NHS does not have the capacity, then the private sector could be used with

the NHS picking up the cost. The principle could be applied more widely. No doubt a move in this direction would prompt scaremongering and misrepresentation. Bravery and determination are

needed. But if NHS patients are getting a better service in five years time it would be vindicated. The risk of allowing the NHS to struggle on as it is, is greater.