The likely (much) wider politics of the NHS (2025- 2035)

No one can ever predict what will happen in the future.

But I think it very likely – and so do many others – that the Labour Party will win the next election.

No one can ever predict what will happen in the future.

But I think it is very likely – and so do many others – that once in opposition the right of the Conservative Party will take over leadership of the Party.

No one can ever predict what will happen in the future.

But it is possible that the new leadership of the Conservative party will return to its post-World War 2 position and withdraw support from the NHS as the model of health care for Britain.

I know that’s three “what ifs”. And that we only reach the possibility of the third if the first two happen.

But here we are approaching Easter 2024 with an election around the corner, so it seems to me not a complete waste of time to think through what the wider politics of the NHS might be during the years 2025-2035.

Last July I wrote a post drawing heavily on a Daily Telegraph article by Allister Heath from January 2023. Early every morning I read the Telegraph comment pieces (so you don’t have to).  These are not just unremittingly hostile to the basic principles of the NHS but are very gloomy about the next few years for the entire country.

As you might imagine these often suggest that of the many symptoms of our national malaise one of the main causes is the NHS and the money spent on it.

It’s no secret that some part of the right of politics doesn’t like the NHS. They didn’t when it was born, and see it as being at best an anachronism, and at worst a blot on the British psyche.

So, today’s “what ifs” emphasise that I think there’s now a real possibility that a major political party will be suggesting to the British Public that it asks for a mandate to finish the NHS.

I am not suggesting that since 2010 there has been a secret plan to privatise the NHS. I don’t like using conspiracy theories to explain anything. The campaign would be open and public. So I want to repeat what is being publicly said by significant commentators. I want to suggest that there is a path for these ideas to move off the pages of a newspaper and into the mainstream politics of our society.

And if that happens all my recent posts about the 10-year NHS plan will take on a different meaning.

The January 2022 article was called “The NHS is dead – and it’s dragging the rest of the country down with it.” The title reflects the whole approach. It’s not just that NHS is a bad institution, but it is destroying the country.

If you believe that, and you love your country, that set of connections is a call to action.

“Millions will go private over the next few years, paying for operations or taking out insurance. Private GP services will boom. This will begin to normalise independent health care undermining the pernicious idea that it is somehow wrong to pay for health.

Yet this won’t be enough. As with Brexit, truly radical change to funding and delivery of health care will require a professionally executed grassroots campaign for change followed by a referendum. The struggle must begin immediately and needs to be fronted by concerned doctors and nurses, including whistleblowers who have seen the destruction wreaked by an amoral bureaucracy. The public will trust medical professionals’ motives but not those of MPs, economists and business leaders.

I regularly speak to GP’s or consultants who tell me in confidence that European or Australian style insurance scheme is the obvious answer and that copayments are necessary to discourage frivolous demand They back fines for missed appointments, highlight the mismanagement corruption holding back many NHS trusts and tell me they want to leave the country. Such people possess the moral high ground:  they need to go public and fight for the modern non-ideological public private universal health service that Britain deserves.

Voters will probably want to give Labour one last chance to fix the NHS but when Keir Starmer falters just as badly as the Tories the electorate will rapidly become desperate for alternatives. If the reformers play their cards right and start campaigning today, a political revolution of a magnitude equal to Brexit could be possible before the end of the decade.”

This is not wild talk. It is a measured, thought through, political timetable. It recognises that the policy of holding a referendum on the future of the NHS will not be in the Conservative Manifesto of 2024. In any case that doesn’t matter as he prophesies the voters will probably elect a Labour Government.

That places the timetable for the proposed referendum on the NHS about 8 years or so away. It places the election after this in 2028/9 and a possible referendum in the middle of the Parliament after that. And crucially he is arguing to ‘start campaigning today’ and for at least 8 years leading up to the referendum.

For the rest of this post let’s pretend that in 2026 or 2027 this jumps off the page of the Telegraph and, given a new leadership and direction of the Conservative Party, becomes part of the platform of the new leadership of the Conservative Party. Is that likely? I would put it at about 50/50 but it’s definitely worth thinking through the politics.

Calling for a referendum is not an unreasonable political position. As with Brexit it puts the decision in ‘the hands of the British people’.  I have no doubt (and I suspect Allister Heath agrees) that if such a vote were held in 2024 the NHS would be backed by the British people.

This is where politics jumps off the page of the newspaper and becomes real. We know that in 2023 only 39% of the public are satisfied with their experience of the NHS. (I suspect that number will fall in the 2024 social attitudes survey).

But as he suggests, “Voters will probably want to give Labour one last chance to fix the NHS but when Keir Starmer falters just as badly as the Tories the electorate will rapidly become desperate for alternatives.”

This political projection is based on the belief that by 2029 many more people will have experienced the NHS as failing to deliver for them. A further assumption is that it will be the Labour Government that wll have failed to work with the NHS to improve delivery.

This assumes we hit the 2028/9 election with more people waiting longer and longer.

Unless we all, now in 2024, start to think hard about the big politics of this issue, in the 2030s  those that want to keep the NHS will be hit with an emotionally powerful clinician-fronted, hedge fund backed, campaign which will base itself on real daily problems faced by millions and millions of people. The argument will not only be based on anti-NHS ideology but on the bad health care experiences that millions of people will have endured for more than a decade.

There will be many people who will argue that the NHS is an important part of who we are and will campaign to keep it. But if the day-to-day NHS experience of millions of people is a bad one the argument about principles will be juxtaposed with people’s real live experiences. That makes it a difficult argument to win.

Since January I have been working through a number of changes that, over the next decade, the NHS needs to make. I have hopefully been explaining in some more detail how those changes might be brought about.

Now let’s put this argument for change into the wider political context of today’s post. Those changes in the NHS would be taking part against a political backdrop where every service failure will be on the front page of the newspapers as a failure of the NHS.

All the way through my posts I have argued that in the face of every argument for change; arguing for greater skill mix; more prevention; moving care into the home and greater use of technology – all of those changes will be contested.

For example, some professionals may well argue (they already are) about Physician Associates, and against a greater skill mix. They will probably be arguing that NHS health care cannot be delivered by non-clinicians. They will say it is an ‘attack on the NHS’.

But if I am right, at the same time as arguments resisting change are saying that they would be the end of the NHS, there will actually be a very public and well-funded campaign that, front and centre, will be arguing for that outcome.

What I am suggesting is that this bigger, national politics will have a serious impact on the arguments about, and internal politics of, NHS change.

One of the arguments that many of us in favour of reforming the NHS make is that if we don’t reform, improve productivity, shift its model of care, it is in danger.

Making that argument when newspaper front pages are actively running a campaign to end the NHS change the wider meaning of this argument.

Put simply I think it means that if, by 2029, we haven’t developed an NHS which is giving millions of patients a better service then there are people around who will really want to kill it.

This makes the next five years of change pretty important!

P.S. Readers may feel that the Telegraph has softened its line recently. Far from it. On March 13th this year Robert Tombs wroteIt may be too late for the West , a corpse that cannot be galvinised”. As I suggest the language has become pretty extreme. A week earlier, in response to the budget, David Frost said, “The NHS treats us like paupers and expects us to be grateful”