The NHS needs more than just cash. It needs major reform too

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By Simon Jenkins

An NHS boss says just show them the money, don’t ‘politicise’ the health service this election. But its problems run deeper

Don’t politicise the NHS say the health professionals. Let us get on with the job. The health service providers’ chief executive, Chris Hopson, pleads for the health service not to be “weaponised” or “demonised” in the election. Just give it more money.

The NHS has been political since the day it was born. Politics has served it well, making it ever vaster and ever more resistant to change. More than any country in Europe, it has maintained its archaic professional structures and its iconic free status “at the point of delivery” (except for drugs), because its leaders know well that “point of delivery” is code for votes.

Every time a participant on the BBC’s Any Questions lauds the NHS “for saving my mum’s life”, I want to cry: That’s its bloody job! How many lives did it not save?

The NHS is often compared to a state religion. Like the medieval church, it relies on blind faith to elicit taxes and to refuse reformation. On its 70th birthday last year, it congratulated itself on 90% of Britons supporting it and 77% wanting no change. Anyone who dares attack the NHS will suffer eternal damnation.

Yet no other European country has copied the NHS model in half a century. Almost all comparable countries are winning more resources from their taxpayers, and most outperform the NHS in health outcomes. UK cancer survival rates lag behind those of comparable countries, A&E delays are increasing, the number of operations being cancelled is dire, staffing rates are in freefall and the tick-box target culture is sending doctors and dentists screaming into the private sector. The UK has one doctor for 356 people, against a developed world average of one for 277.

The NHS’s archaic divisions of labour between GPs, hospital doctors, pharmacies and clinics is now indefensible. So too is the division between the NHS itself and social and domiciliary care. As any victim of these restrictive practices knows, treatment delayed is treatment denied.

Sooner or later, the pressure of demand (now from all age groups) will force the NHS to choose between rationing by some form of means-tested pricing or by further bureaucratic delay. Last year’s Guardian survey of foreign systems showed there were plenty of other ways to organise public health. Most involve localisation and the merging of physical and mental health with social care. Before the coming of the NHS, London’s (local) health service was regarded as the best in Europe. It is not that now. A first step was made while David Cameron was prime minister to devolve Manchester’s health to its local government. Early reports suggest this is working.

Health is too important and sensitive a service to be delivered by means of a corporate state juggernaut. It must decentralise. Just as paying for it has been political, so now should be changing it.