The NHS is falling to pieces before our eyes and there’s no sign that any frontline politician is prepared to show the courage needed to save it.
Nevertheless, ambitious and sustainable reform of the NHS is achievable if the political will did but exist — we at Policy Exchange have set out a detailed, practical and realistic plan for how a UK Government prepared to show the decisive and courageous leadership necessary could achieve it within 1000 days.
Despite very significant real-term increases in spending over recent years, public satisfaction levels with the NHS are at all time lows. Just one in five people are now satisfied with the way the NHS runs. This should not be at all surprising.
There are over 7.3 million people on NHS waiting lists, with 62 per cent of patients waiting over 18 weeks and 19 per cent waiting over a year for non-emergency elective treatments.
On many major health metrics, including mortality and cancer survival rates, the UK lags behind comparable European countries.
The reflex answer of successive Governments has been to assume that either increased funding or yet another initiative to improve efficiency will finally solve our long-standing healthcare underperformance. Yet NHS spending is now over £242 Billion — larger than the entire GDP of Portugal and still many parts of the health service continue to regard themselves as under-funded.
The sheer scale of healthcare spending increases — a trend which does not look likely to change any time soon — is entirely unsustainable and if bold action is not taken, will ultimately lead to the collapse of the NHS.
We must avoid the comforting delusion that we are somehow unique in the UK in having a universal healthcare system or that the only alternative is some dystopian American model in which only those who can afford to pay receive good healthcare.
The reality is very different and is almost on our doorstep — just across the Channel anyway, where an example exists which presents a ready-made model for any politician prepared to take notice and show real leadership.
In the early 2000s the Netherlands was wrestling with many of the same challenges which the NHS is facing now with long waiting lists, rationing, spiralling costs and growing public disenchantment with endless initiatives designed to control costs.
Now the Netherlands has one of the best performing healthcare systems in the world — beating the UK on nearly every major health metric (including avoidable mortality, self-reported ill-health, satisfaction rates, waiting times and survival rates) , while sending a lower proportion of GDP every year paying for it.
The key to this transformation was the bold and determined leadership of the Government at the time, most particularly the then Health Secretary Hans Hoogervorst who saw through a complete remodelling of the health service to put patients in control, increase choice, encourage new providers to enter the system and importantly, to retain the universality and “solidarity” which Dutch political culture values so highly.
The Netherlands introduced a system of compulsory social insurance in healthcare. There is a standard “basic insurance” policy which everyone over the age of 18 must take out (low earners receive very significant subsidies towards their premiums out of central taxation.)
An insurer needs to offer everyone the same price premium — although they are allowed to compete against each other on the “one price” they offer customers. They are not allowed to turn anyone away because of their health or health risks — and a system of “risk equalisation” is in place to compensate insurers who end up with disproportionately more costly subscribers. There is also a system of co-payments for certain services to help manage demand and as a source of additional funding for the system.
People can “shop around” amongst a range of insurers on the basis of price, quality of care and treatment, customer service, convenience, and breadth of network. This is a highly competitive market and insurers are thus strongly incentivised to secure the best value and outcomes for their patients.
This in turn has incentivised healthcare providers (surgeries, clinics and hospitals) to adapt and innovate to become more patient orientated, setting up in new more convenient locations, delivering new services and providing better quality care.
The Dutch Government has moved from providing the services directly itself to focussing more on protecting the interests of patients — regulating the quality of care and ensuring that the basic health insurance policy continues to operate effectively and to reflect patient needs.
From a patient perspective this system means that universal healthcare remains in place but that it is now much more genuinely accessible and responsive to more people.
We’ve certainly reached the point where this kind of reform is needed
Despite operating in a similar political, economic and cultural context to the UK and despite facing the same problems such as the prices of medicines and an ageing population, the Netherlands has succeeded in both improving services and halting the increase in system costs over time — indeed now they spend a significantly lower proportion of GDP on healthcare than the UK does.
We may not yet have reached a point where politicians are ready to show this kind of leadership on health — but we’ve certainly reached the point where this kind of reform is needed. Our plan is ready and waiting for any political leader prepared to pick it up and to save the NHS.
