Calendar An icon of a desk calendar. Cancel An icon of a circle with a diagonal line across. Caret An icon of a block arrow pointing to the right. Email An icon of a paper envelope. Facebook An icon of the Facebook "f" mark. Google An icon of the Google "G" mark. Linked In An icon of the Linked In "in" mark. Logout An icon representing logout. Profile An icon that resembles human head and shoulders. Telephone An icon of a traditional telephone receiver. Tick An icon of a tick mark. Is Public An icon of a human eye and eyelashes. Is Not Public An icon of a human eye and eyelashes with a diagonal line through it. Pause Icon A two-lined pause icon for stopping interactions. Quote Mark A opening quote mark. Quote Mark A closing quote mark. Arrow An icon of an arrow. Folder An icon of a paper folder. Breaking An icon of an exclamation mark on a circular background. Camera An icon of a digital camera. Caret An icon of a caret arrow. Clock An icon of a clock face. Close An icon of the an X shape. Close Icon An icon used to represent where to interact to collapse or dismiss a component Comment An icon of a speech bubble. Comments An icon of a speech bubble, denoting user comments. Ellipsis An icon of 3 horizontal dots. Envelope An icon of a paper envelope. Facebook An icon of a facebook f logo. Camera An icon of a digital camera. Home An icon of a house. Instagram An icon of the Instagram logo. LinkedIn An icon of the LinkedIn logo. Magnifying Glass An icon of a magnifying glass. Search Icon A magnifying glass icon that is used to represent the function of searching. Menu An icon of 3 horizontal lines. Hamburger Menu Icon An icon used to represent a collapsed menu. Next An icon of an arrow pointing to the right. Notice An explanation mark centred inside a circle. Previous An icon of an arrow pointing to the left. Rating An icon of a star. Tag An icon of a tag. Twitter An icon of the Twitter logo. Video Camera An icon of a video camera shape. Speech Bubble Icon A icon displaying a speech bubble WhatsApp An icon of the WhatsApp logo. Information An icon of an information logo. Plus A mathematical 'plus' symbol. Duration An icon indicating Time. Success Tick An icon of a green tick. Success Tick Timeout An icon of a greyed out success tick. Loading Spinner An icon of a loading spinner.

Andy Maciver: Leaders know NHS in its current form is over. They just don’t know how to tell us

© Andrew CawleyAmbulances at the Queen Elizabeth University Hospital in Glasgow
Ambulances at the Queen Elizabeth University Hospital in Glasgow

In my line of work, I am in touch with politicians on a daily basis. Behind all the negative headlines about lies, deceit and scandal, the vast majority are normal, hard-working folk who want to make life better for the people they represent.

Politicians do not set out to mislead you; except, that is, when it comes to the NHS. The NHS, as the saying goes, is as close as this country comes to a national religion. In the past, the way that we revere “our NHS” would make you think that we are the only country in the world with a hospital; that in Sweden they have no surgeons, that in New Zealand they have no nurses, that in Belgium they have no beds.

But everything is changing. The moderate politicians I speak to from all parties know this. They know that the NHS, in its current form, is over. They just can’t figure out how to tell you that, and what to build in its place.

Labour’s Wes Streeting is not ducking this issue. This is good news for all of us, because it is generally the case in all countries that difficult public service reform has to be carried out by the party of the centre left in order to ensure it has a softer edge. If Labour wins the next general election, and Streeting changes the weather, we can expect the wind to reach Scotland.

The basic facts, according to the Organisation for Economic Cooperation and Development, are grim. The nations of the UK inject an average amount of money into healthcare, as rich countries go. Not the most, but not the least. But despite being in the middle of the table for money, we are nearer the bottom for outcomes.

Our survival rates for stroke, heart attack and cancer are lower than our peers. And we have a very small proportion of doctors and nurses at work and in training, and a very small number of beds, compared to our near neighbours.

That is the heart of the NHS’s problem. It is not the quality of our staff or the money we invest; it is the fact that the way we structure our system creates a lack of capacity, which creates these hideously long waiting lists and poor outcomes.

Our continental neighbours have systems which, like ours, provide universal, taxpayer-funded access to healthcare but, instead of all the money coming from national taxation, an element comes from those who have the means to pay more. This is a form of social insurance to guarantee healthcare for all, unlike in the USA.

So, workers might pay a little more each month for healthcare, just as they do for their pension, in order to have the right to choose a different level of access, in effect leaving more in the pot for those who cannot pay to access a quality level of healthcare. In Europe they call this egalitarianism; here we, wrongly, call it privatisation.

Streeting’s challenge is to stop knee-jerk talk of privatisation and a two-tier service and make people understand that the NHS is a mid-20th Century anomaly which just doesn’t work.

There are strong signs that people are ready for this debate, and this change. YouGov regularly tracks regard for the NHS compared to other European healthcare systems. Three years ago, just before the Covid lockdown, twice the number of people thought the NHS was better than European healthcare systems than vice versa. Last month, more people told YouGov that the NHS was worse than told them it was better.

Good luck Wes Streeting. You have a treacherous journey ahead in a car full of unsettled passengers. Now drive.

Andy Maciver is founder and director of Message Matters and Zero Matters