Don’t be fooled by anti-NHS myths – paying more tax for it makes sense

The argument that the health service is too big to manage – and too expensive to pay for – is rot

The NHS: a lumbering, bureaucratic, money-eating monster that would trip over its own feet no matter how much cash was pumped into it?

This is a narrative which has regrettably secured some traction in Britain. You’ll frequently hear it from think tanks, commentators and some politicians. Most of them are on the right – but not all. Unfortuntately, the notion that the NHS is too big to manage and too expensive to pay for has seeped into parts of the public consciousness.

Nevertheless, the argument is rot. The empty heads touting it aren’t quite on a level with those who deny the harsh reality of climate change or who spew forth claptrap anti-vax conspiracy theories – such as how the life-saving Covid vaccines were a plot by Bill Gates to get nanotech microchips into our arms – but they swim in the same fetid swamp.

The truth is that the NHS actually does a fine job of providing mass healthcare. If we were willing to pay what it needs to live up to its founding principles – and we should be – its critics’s cynical attack line would be coughing up blood at the side of the road. Anyone need a free ambulance?

One of their favourite ploys is to highlight inefficiency and waste, resting on specific incidents which find their way into the media. But here’s the thing: you can always find something in any large organisation. That includes even hyper-efficient tech companies such as Gates’s baby Microsoft. Read up on the Zune.

Looked at in the round, however, the NHS does very well. Sajid Javid, no one’s idea of a spendthrift pinko, noted in a speech in March – while he was serving as health secretary – that admin costs account for just 2p for every pound spent compared to 5p in Germany and 6p in France. That’s an efficient health service. Score one for Nye Bevan’s baby when set against insurance-based alternative models.

Let’s turn to the “bottomless pit” argument. By 2019, this country was spending 9.9 per cent of GDP on healthcare, roughly where it had been in 2011, slightly above average globally, but lower than comparable nations – such as France and Germany.

Since the NHS was founded, however, Britain’s population has grown and is now rapidly ageing. Technology, which has enabled us to treat and sometimes cure conditions that might once have represented a death sentence, has also advanced. To cope, health spending has needed to rise. Historically, per the King’s Fund, an independent health think tank, it has done that at roughly 4 per cent in real terms, fuelled by the proceeds of economic growth. And rightly so: do we really want to mimic America where people needlessly die for the lack of treatment?

However, in the decade following the 2008 financial crisis, the Tory government punched the NHS in the gut with the most prolonged spending squeeze in its history. Between 2009/10 and 2018/19, spending increased by an average of just 1.5 per cent per year.

A little more money has recently been made available. Spending was slated to increase by more still to help the service cope with the aftermath of Covid. But not to the level of its long-term average. And the necessary extra funds were supposed to have come from the health and social care levy that short-lived prime minister Liz Truss scrapped. It was the one part of her economy-wrecking plans that new chancellor Jeremy Hunt failed to reverse.

The spending squeeze the NHS has endured has had a significant impact, not just in terms of waiting lists or cancelled appointments – Diabetes UK, for example, says just 36 per cent of people with type one and/or type two in England received all their recommended care checks in 2020-21.

People have been warning of the threat of a “two tier” system for as long as I can remember. It is here. Earlier this year, the Institute for Public Policy Research reported that “long-term decline in NHS access and quality rapidly accelerated by the pandemic, has begun to supercharge a trend of people opting for private healthcare and products”.

The compilers of “State of Health and Care” commissioned a poll, which found 31 per cent of respondents had found it difficult to access NHS services during the pandemic. Some 12 per cent had resorted to private healthcare – the equivalent of around 2 million people.

Private physiotherapists offering rapid access to treatment for those who need it, and more than the standard six sessions for those who can pay, can easily be found on the high street. Mental health support – all but impossible to access via the NHS – is another popular private choice.

These services can be quite pricey unless you have private insurance. That too has become more popular. The trouble with it is that insurers are only interested in covering the healthy. Duh. Unsurprisingly, the IPPR found “top-ups” were most common in London and among wealthier socioeconomic groups. Of course they were.

Supporters of private healthcare will ask what the problem is. It frees up resources for others. Except they are not there. Those without the ability to access them have little choice but to suffer in silence.

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This oughtn’t be necessary. It wouldn’t be necessary if politicians were honest with people about what it would cost to properly fund the NHS in terms of taxation, and if they were prepared to make the case for higher spending. Neither of the two main parties is being straight with the voters here, nor are they willing to make the case for better funding through tax.

The irony is that it was Boris Johnson, perhaps the most mendacious PM in history, and his chancellor, Rishi Sunak, who came the closest with their levy.

I was dubious when it was announced. I felt the timing, with the economy just coming out of Covid, was suboptimal. But the idea was sound, and I confess I should have argued more strongly in its favour. Polling has repeatedly suggested people would support paying more tax for a better NHS. And why not? It makes sense. The NHS offers great value for money. We can fund it to enable it to provide the services people require for free, at the point of need. And we should.

Not to put too fine a point on it, but one of the main reasons for the labour shortages employers are always moaning about is a sharp increase in long-term sickness. There is thus a strong economic case for improving the health of Britain’s workers, quite apart from the moral case. It is unimpeachable.