The NHS paradox: our healthcare system is the envy of the world and our healthcare system is failing. These phrases inherently contradict one another, so why is the UK so adamant they can be true at the same time? 

Now that we view the NHS as our hero it is almost impossible to implement the real reform which is necessary for it to actually be the envy of the world.

The IPPR released a paper last week about how the NHS’ failings are driving more people to private options which creates a ‘two tiered healthcare system’. While I accept the premise: that the NHS is performing inadequately; I reject their solution: to pump more taxpayers’ money into the NHS.

The flaws in our healthcare system are too vast a wound to be patched up by cash. We already spend £3,400 per person annually on our NHS. The NHS budget has increased by an average of 1.4% (inflation adjusted) between 2009 and 2019. What reason have we to believe that the IPPR’s suggestion of taking nearly £50bn from taxpayer pockets over the next three years will solve the problem? 

Success in healthcare does not always correlate to the amount of funding. Many countries around the world have higher survival rates and lower waiting times while spending less of their GDP on healthcare. Your chance of surviving stomach cancer is over 200% higher in South Korea than in the UK despite healthcare costing them 8% rather than 10% of GDP. The average waiting time for cataract surgery is nearly 3 times as high in the UK than it is in Italy, a country that spends 1.5% less of GDP on healthcare. Singapore is widely recognised as having an incredibly effective healthcare system, while devoting only 4.08% of GDP to it. If countries with less funding can repeatedly outperform the UK, then the argument that the solution is to pump more money into our failing system and cross our fingers falls flat. 

Improving our healthcare is only becoming more important with an ageing population, increasing prevalence of mental illness and the vast backlog caused by COVID-19. This is causing the previous structural cracks to form visible structural problems.

Although exacerbated during COVID, with median waiting times for treatment over 19 weeks in July 2020, failures in this area were evident beforehand, as average GP waiting times were already over 2 weeks in 2019. The result is clear: those who can afford it go private and those who can't are left with lower quality healthcare services.

The way to prevent the ‘two-tiered’ system that the IPPR refers to is to allow everyone access to a higher quality of healthcare. A poorly structured state-run behemoth competing with private healthcare will never create this. The differing incentives between private and state-run bodies naturally create disparities in quality. 

By changing the NHS funding model we can align the two more closely. Private facilities are paid per service, incentivising them to attract as many patients to receive the service as possible. The result of this is higher quality services. Whereas NHS surgeries are paid per patient meaning regardless of the standard of service the practice receives the same funding. 

State healthcare and high quality healthcare should not be mutually exclusive. By structuring the NHS to treat patients as consumers rather than burdens, it can remain free at the point of delivery without sacrificing quality.

If we gave patients more freedom by allowing them to seek services from any surgery and funded practices per appointment their incentives would align with that of a private facility. GPs would compete for patients by reducing their waiting times and improving their customer care. This would unlock the benefits of markets without the price of private care. 

Let's put patients, rather than bureaucracy at the heart of our NHS.