Only foundational reform can fix the NHS

Sir Keir Starmer has said nothing is ruled out when it comes to reforming the NHS. The service is so broken that Labour is no longer wedded to the idea that it is “the envy of the world” and the party is open to changes that will make it perform better.

This might well sound like the beginnings of the debate this country has needed for decades regarding the future of health care, but it is not what it seems. To begin with, something is off the table, namely the “founding principle” dating to 1948 that health care should be free at the point of delivery. Indeed, it is this principle that is the basis of the “envy of the world” claim, that everyone, no matter how poor, can access treatment without having to pay, or not directly.

In fact, Sir Keir has already suggested a future Labour government would legislate to enshrine this principle in law, even if it turns out that it is a sentimental attachment to the formative ideology that is causing most of the difficulties in the NHS.

In order to fulfil the ambitions behind the 1948 dispensation, it was necessary to turn the NHS into a gigantic nationalised behemoth. While other state-run industries were privatised over the decades, the NHS retained its status as the untouchable institution, tinkered with at the edges but essentially left intact.

Sir Keir and Wes Streeting, the shadow health secretary, are right to say that the NHS cannot survive in its current form. Arguably, this has been apparent for the past 30 years without any serious attempt at reform. But, while acknowledging a role for the private sector, their prescription is actually for more nationalisation, not less. They want to turn GPs into salaried employees of the state rather than the self-employed free agents they have been since 1948.

They are right to identify a serious problem with primary care, but making the NHS an even more unwieldy bureaucracy of the sort Sir Keir correctly criticised as “nonsense” in The Sunday Telegraph will not help.

Until Labour understands that the main problem with the NHS is that it is a nationalised industry funded almost entirely from taxes and with all the consequent inefficiencies hard-wired into its processes, then there is no prospect of the fundamental improvements they claim to want to see. This inefficient health service will continue to devour more of the nation’s resources while outcomes get worse.