Does Wes Streeting's shift to the right on NHS reform leave space for sensible, and popular, Conservative reforms?

It is becoming apparent across the political spectrum that the NHS is not up to snuff. Waiting lists are a global embarrassment and the quality of hospitals is risible.  Reports from wards show elderly patients lying in their own excrement and patients waiting hours for treatment in A&E for a transfer to a ward. Meanwhile there are an estimated 14,000 patients every day who are fit to go home yet, due to the lumbering ineptitude of the NHS, are taking up beds which other patients need.  

These patients stuck on wards who are ready to go home are losing muscle – leading to a risk of falls and fractures - and risking communicable diseases. Meanwhile the waits in A&E have been estimated to cause almost 300 avoidable deaths. 65 per cent of people left in A&E for 12 hours or more were waiting for a bed – more than one million patients a year.

Patients wanting to get home and others wanting to get in - and both cohorts suffering. And why? Because hours each day are taken up with clinicians sitting in meetings working out who can be discharged and chasing up physiotherapy or occupational therapy assessments, social work assessments, care plans and then trying to discover if that care is even available. Bed capacity and management is, in many parts of the NHS, a perfect example of the paper based, manual process that, far more than ‘underfunding’ is the cause of NHS failure and patient dissatisfaction.

In the most recent budget the Chancellor announced £3.4 billion of new investment in digitisation for the NHS. But the minimal accountability of the NHS to the people who suffer most from inefficiencies – patients – means that there is little incentive for NHS Trusts to undertake difficult and potentially contentious changes. Trusts in England have underspent on tech funding this year.

It is not even that all staff are content with the inefficient, outdated methods. The large numbers of complaints from staff would indicate otherwise. Perhaps staff happiness and patient health just isn’t as great a priority as ensuring any communications for the OBGYN ward doesn't include the word 'women'?

This is the fundamental problem of the NHS. It is unaccountable to everyone – staff, patients, and even the Government.

Who runs it? It’s not the Health and Social Care Secretary – she can’t even get staff to go to work. It’s not the Head of NHS England – they just hand out the money. Is it the Chief Medical Officer? Is it the chair of one of the 42 Integrated Care Boards? Or maybe the CEO of the NHS Trusts? Or the head of the BMA? Or a particularly efficient administrator in the local community mental health trust? Or maybe it’s Stan the gardener, one of 100,000 people employed by the NHS in Estates and Facilities Management?

It’s no one. No one is in charge. And when something is unaccountable, the blame for incompetence and failure gets shunted around and the poor people at the end of the chain – the patients – see no resolution and no improvement.

There would never be enough space in one article to write about the problems facing healthcare in this country, not least the attitude which leaves many people thinking that they should take no responsibility for their own health and the 'tragedy of the commons' which a free at the point of use health service inevitably brings. 

But while other Parties are banging the drum on NHS improvements, neither seem particularly likely to go to the root of the matter and fundamentally reform it in order to make it accountable.

Wes Streeting has announced that Labour will be requiring the NHS to use private sector capacity and that additional money will only be given to the NHS if they work at weekends – something which the private sector does as a matter of course. Richard Tice has promised additional funding whilst avoiding ‘bungling NHS bureaucrats’.

But can we really believe Streeting when he promises to be ‘up for the fight’ against his union paymasters (not to mention a left flank that sees any diminution of the Bevanite NHS model as akin to heresy)? And, since most NHS funding goes through Integrated Care Boards whatever it is supporting, can we really take Tice’s promise seriously?

If the Government is not willing to reform the NHS, then there is one policy they should adopt before the General Election – Reform’s pledge for tax relief for private health care.

There is no question that failing to reform the NHS for the future has meant an increasing number of people paying to go private. Like Margaret Thatcher, they pay their dues to the National Health Service but do not add to the queue.

Why, given they have paid for the NHS already and the British economy is facing the heaviest tax burden since the War, should they not be able to claim tax relief?

The Conservatives rightly attack Labour’s assault on private schooling but ignore the obvious double standards for charging tax on private health care. Like with schooling, it discourages people from using alternative providers and forces more people into the overwhelmed NHS.

A popular Conservative Party would want people to be able to spend their own money how they think fit, would support the efficiency and growth potential of the private sector and would not put the beatification of the NHS above people’s own health outcomes.