This is the year that we reform the NHS”, according to the Prime Minister in a speech he gave this week setting out how he intends to end “hospital backlogs”.
There’s little new in this messaging. Labour’s plans are rooted in a cross-party consensus on how to bring down waiting times – many elements of which have been fixed since the Blair Government, with greater use of the independent sector to improve capacity and an expansion of community diagnostic centres.
Still, Streeting’s announcement earlier this week is a welcome one that takes forward many long-standing recommendations like increasing direct referrals from GPs and an expansion of remote monitoring. But as the Health Secretary understands well, a far more radical program of reform will be necessary to rescue the NHS from its increasingly low position in public perception.
The findings of Policy Exchange’s new report, A Portrait of Modern Britain: Health, examines the public’s priorities for NHS reform, revealing an openness for more far-reaching changes. Despite popular narratives, “free at the point of use” has become less of a priority (41 per cent) to the public than delivering care effectively either through treatment of life-threatening conditions or access to GPs services (61 per cent).
For decades, the conventional wisdom has been that the NHS – more specifically, the free at the point of use model – is too popular for politicians to challenge. Even Thatcher was of the view that abolishing the NHS was a step too far in her ambition to roll back the frontiers of the administrative state. And despite Nigel Farage entertaining the idea of a French insurance model during the 2024 General Election debate, the Reform manifesto stuck to safe ground, promising “cuts to waste” and “improved efficiency”.
But this polling shows that we are approaching a tipping point, in which widespread dissatisfaction with the failure of the NHS is becoming increasingly salient in conversations about the fundamental changes that need to be made, particularly amongst younger people. That does not mean the public has rejected the latter principle – far from it. But it does open space for the Health Secretary to consider more larger reforms to the model – as long as this results in improved services. This was the bargain struck when prescription charges and co-payments for dentistry were first introduced in the early 1950s.
There is also an interesting age dynamic around attitudes towards GPs acting as gatekeepers for care. Both young people and people living in urban environments are markedly more likely to prioritise reforms allowing patients to direct access to secondary care. For a generation who have grown used to ordering services on demand over the internet, the GP gatekeeper system seems archaic. The Government is already introducing some steps towards direct referral for patients, but there is room for bolder reform through an expansion of “community clinics” where patients can be seen by a mix of expert generalists (GPs) and specialists side-by-side.
There are still some more obvious (and relatively easy) changes the Government could introduce, such a “three strike” rule with a fine for those who repeatedly miss GP or hospital appointments. Meanwhile, restricting entitlement for free prescriptions to only those who genuinely need it could save over £2 billion a year.
The complacent assumption that the NHS will survive in its current form forever, and that any suggestion of radical reform will always be politically unsustainable, should be roundly rejected. It is simply false – and that’s good news for those who recognise the scale of change the service must undergo.
John Power is Senior Fellow in Health and Social Care at Policy Exchange
Broaden your horizons with award-winning British journalism. Try The Telegraph free for 1 month with unlimited access to our award-winning website, exclusive app, money-saving offers and more.
