Laura Kuenssberg: The NHS is here to stay, love it or hate it

Laura Kuenssberg and NHS employees appear in this composite image

The NHS is a subject of love and hate among Britons.

The King's Fund researchers found that the public gave the NHS its lowest rating since records have been kept 40 years ago. In 2022, only 29% of people reported being satisfied with the NHS.

Yet we continue to adore it. The majority of people—90%—agree that the service should be free and open to all.

But with over seven million people on waiting lists, almost everyone is aware of someone who isn't receiving the care they require.

Politicians are swooning over the NHS as it approaches its 75th anniversary and offer nothing but praise.

The message you hear, however, might be quite different if the cameras aren't rolling. Politicians, like the rest of us, have a love-hate relationship with the NHS.

"The entire system is paralyzed and not improving; all forward movement is being reversed. That's not the kind of thing you hear a minister say in public, but when a former health minister is speaking privately, he or she expresses an honest opinion.

They claim that because the demand for care is outpacing the supply, the NHS chief executive has taken on the role of "rationer-in-chief" and is responsible for "spreading the jam more and more thinly.".

The National Health Service, according to a different former Conservative minister, is a contradiction because "the leadership is incredibly patchy and outcomes are mixed.".

For Labour, a source claims that there is growing "anxiety and jeopardy" regarding the service's future and that "it really is a case of change or die.".

A politician would be hard pressed to admit that services are being rationed, but in off-the-record conversations, the phrase keeps coming up.

The "trade-off" with the conventional model, according to one of the former ministers, is that "people have to understand that there is rationing according to wait.".

People are aware of rationing, and the service is generally good when they receive it, but this is not always the case, according to a former government adviser.

There are no political flyers or Facebook ads that mention health rationing.

The public's adherence to the NHS concept, however, is still very strong. Voters are not in the mood to discuss changing the party's core values, both before and after the pandemic, despite all the issues.

According to the former government health adviser, it is virtually impossible to have a serious discussion about fundamental change.

They claim that if they even suggested a radical change, "any sophisticated Tory politician knows they'd sign their own death warrant.".

Remember Prime Minister Rishi Sunak's suggestion that patients be fined if they missed a doctor's appointment? It was dropped almost immediately after it was made.

It's like your family, as another former official put it when describing the public's strong emotional attachment to the concept of the institution. I'll whine and whine and whine about it, but if someone else outside of my family picks on them, I'll put them on toast. It's like saying, "They can naff off, stop criticizing your football team!".

Numerous politicians have discussed changes to the service, including working with the private sector and this week's workforce plan. But regardless of whether it is necessary or not, it is now all but unimaginable for any mainstream politician to advocate for a fundamental overhaul of the entire system.

Of course, that affects what the government decides to do in order to try and improve the service, which may not be the best long-term strategy.   .

Politicians prefer solutions with simple metrics, like reducing waiting lists, a former official advises.

"If you do reduce them temporarily, that just results in more operations and doesn't address preventing people from getting sick in the first place. " .

Following the pandemic, a former minister claims that instead of implementing radical reforms, "we have gone straight back to the voodoo land of heroic pointless commitments that will never get met because as a country we are so ill.".

Bar chart showing that the death rate from treatable conditions is higher in the UK compared with similar countries. United States 88 per 100,000 people, United Kingdom and Greece 69, Ireland 65, Portugal 64, New Zealand and Germany 62, Canada 56, Denmark and Austria 55

Another argument makes the case that ministers are actually afraid to confront the public with the reality of the mounting pressure on healthcare costs. The government is afraid of the unreal expectations the public has of what we can deliver, they claim.

Furthermore, as we've discussed frequently both here and on the show, the rest of the health service must bear the expensive costs of a social care system that, for the most part, is simply broken until governments address the painful gaps in care for the elderly and vulnerable.

One of the ex-ministers I spoke to is extremely frustrated that it is so difficult to have a full discussion about the NHS and claims that "it's a political problem, not a resources problem.". To discuss truly radical changes, our politicians simply don't have the time.   .

Everyone, regardless of their beliefs, is afraid to take it on, according to a former adviser.

But it's also a testament to the NHS's longevity and the public's faith in it that politicians find it so difficult to discuss alternatives.

According to the former advisor, "as a system it is extraordinarily fair and that has to be worth something," even though people must wait and results can vary.

Love it or loathe it. There is no doubt that it will remain.

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