The Week

The Week 5 May 2023

Charlotte Pickles

Between local elections (and the 'pre-election period of sensitivity'), Coronation coverage and (again) the Sue Gray saga, this Week has been a policy-free zone for Whitehall.

So as we await the return of some form of business as usual next week, here's a weekend read on whether, as it approaches its 75th birthday, the NHS can survive the next 25 years.

Rich Taunt's long read has his answer in the title: 'The five reasons the NHS won’t live to see 100'. His five reasons are youth, democracy, weather, profit, and truth, but not necessarily in the way you would assume — and for that reason well worth your time. Here's a brief summary of three of the five reasons.

Firstly, 'youth'. Taunt makes the obvious argument that demographic trends mean “fewer people to do the jobs, yet more jobs to fill”, but he also points out that younger workers are looking for different things from work than earlier generations. It's less about extrinsic benefits (e.g. pay) and more about the intrinsic… and while working in healthcare may be “meaningful”, the NHS is a pretty terrible work environment. Poor work/life balance, burnout and stress, and high levels of bullying, harassment and abuse (by colleagues).

On 'democracy', Taunt makes the case we at Reform have been making. Despite warm words about local integration and autonomy, the NHS is a centralised model, and all eyes turn to the Secretary of State to solve any and all problems. Taunt, I think, overplays the idea of ministers stopping innovation — its handy to paint ministers as the problem, and lessens the accountability of system leaders — but he's spot on that democracy isn't the problem.

The argument most commonly made is that politics should be taken out of the NHS, which is ridiculous given it's spending £160 billion of taxpayers' money and impacts every citizen. The better answer, as Taunt says, is to have the right level of democracy. “It is possible to have a politically led system but one which has local, not national, elected politicians exercising democratic control for their area.” It's a topic we're exploring.

On 'profit', again Taunt is not making the predictable argument. In fact, he's clear “‘more money’ can never be the primary answer to the NHS’ ills; there will never be enough”, so, “whether we like it or not, no publicly funded healthcare system anywhere in the world will ever be able to provide everything”. Which in a world where we can buy alternative care from independent providers — and “whisper it — the care people experience outside of the NHS might well be better than that they receive within it” — starts raising big questions about the model. How, Taunt asks, would the NHS fare against a private competitor with comparable values?

I expect a lot of people will dismiss this idea, but with satisfaction with the NHS at rock bottom and increasing numbers purchasing health-related services (from GP appointments to gut health analysis), it's worth considering.