Last October, Rishi Sunak sat down beside Catherine Poole, a 77-year-old patient at Croydon University hospital, no doubt hoping for a breezy on-camera conversation. When Mr Sunak asked whether staff had looked after her “really nicely”, Ms Poole replied: “They always do. It’s a pity you don’t pay them more.” That sentiment seems to have hardened. Health workers in Britain began their largest strike on Monday and polls showed the public solidly behind them.
The disputes will eventually be settled, but patients will suffer more the longer they go on. Yet it seems that Mr Sunak’s government is in no mood to end the quarrel. That is why Monday’s strike, the biggest in the 75-year history of the NHS, largely affected English health services. Walkouts have been suspended in Scotland and Wales after new pay offers. Ministers need to face up to reality. The NHS in England is in crisis. This might lend weight to the argument that the system is in crying need of correction, yet the health service in England was just reorganised under the Health and Care Act 2022 so that the NHS could plan “integrated” services – reversing a decade of pro-market reforms.
Hugh Alderwick of the Health Foundation wrote perceptively last month that “these changes were introduced under Boris Johnson’s government. Two prime ministers later, Rishi Sunak and his health secretary, Steve Barclay, are emphasising patient choice of provider … to improve the NHS”. The Health Foundation’s polling shows that while public satisfaction in the health system has declined because of waiting times, support for its core principles – free at the point of use, available to everyone and funded by tax – remains as strong as ever.
This faith in the egalitarian and redistributive health system is being tested by Mr Sunak’s parsimony. Overall health spending will now grow by 1.2% a year in real terms over the next two years – less than in the decade before the pandemic (2% a year) and less than a third of the long term average (3.8%). With the NHS unable to provide comprehensive cover, the private sector is moving in. Last year, in the richest parts of the UK, a quarter of all NHS elective care was being delivered by private providers. In the poorest areas, the proportion is more than a tenth.
If wealthier areas see the biggest reductions in waiting times, then it would be another example of inverse care law – where health provision varies inversely with the need of the population served. Having to wait for care encourages people to try to jump the queue. In his forthcoming book, Shattered Nation, Oxford University’s Danny Dorling calculates that in 1980, about 0.5% of GDP was spent on private health insurance. In 2021 it was more than 2%.
Health spending is rising because we are living longer and there are more people with long-term conditions. It is also going up because medical advances allow us to live healthier and longer lives. Prof Dorling says that from the 1970s to 2015, people in 20 countries had longer life expectancy than Britons. By 2021 that was true in more than 30 nations. He argues that this “disturbing and sudden fall was not due to the pandemic; it was due to austerity”. It makes sense to spend money on things that improve our existence – unless, it seems, you are a Conservative minister.