2 July 2024

Labour’s first policy should be to break up the NHS

It would be dramatic and counter-intuitive – but rebuilding healthcare around the doctor-patient relationship is a vital reform.

By Phil Whitaker

Political parties frequently have bold, fully worked up plans not trailed in their manifestos. Keeping radical proposals under wraps minimises opponents’ potential targets for scaremongering. And if elected, subsequent surprise announcements create a potent sense of momentum for the first days in office. The most famous example in recent times was Bank of England independence, a policy Gordon Brown developed in secret over the two years before the 1997 election.

Contemplating Labour’s 2024 manifesto, I wonder what Wes Streeting might have up his sleeve were he to become secretary of state for health. The most dramatic, counter-intuitive but vital move he could make would be to announce the imminent demise of the National Health Service.

In its place he should create two new bodies. One, a National Sickness Service (NSS), would care for the ill. It would have much in common with the NHS of yesteryear but should be built around the relationship that characterises the world’s best healthcare systems, that between a patient and their family doctor. Streeting should close NHS 111, serve notice on the private companies that provide cover out of hours, and roll those budgets into a new GP contract under which neighbourhood groupings of family doctors would deliver round-the-clock care to their patients again.

Alongside the NSS, Streeting should launch the National Disease Prevention Service (NDPS). It might have superficial similarities to the Public Health England of old, but its raison d’être would be to reduce demand on the NSS. Its budget would comprise the monies currently spent by the present-day NHS in trying to do the same job – the gargantuan amounts spent on consultations, screening, checks, investigations and prescriptions.

Currently, decisions about funding these activities are taken in isolation by bodies such as the National Institute for Clinical Excellence or the National Screening Committee. The cost of an intervention is weighed against the anticipated “gain” and if it appears even narrowly cost-effective, it will be recommended. The problem is pharmaceutical companies keep developing new drugs that reduce by an iota the risk of developing a disease; academics continue to devise more technologically advanced techniques for detecting or predicting risk of pathology; charities and lobby groups (frequently industry-funded) continue to press for “their” disease area to be given special status.

But these case-by-case adjudications are made with no reference to the big picture. An NDPS with a finite budget would have to start asking the question that has never been asked before: which of these myriad preventative things that can be done, should be done? Which give the greatest return on investment? Which are of such low value that they can’t be justified at all?

An enlightened NDPS board might also start asking a related question: is funding ever more pharmaceutical and technological approaches to disease prevention actually the best use of our limited resources? We have long known about the damage to physical and mental health caused by socio-economic deprivation, inequality and insecurity; by the activities of the food, alcohol, tobacco and gambling industries; by pollution and environmental degradation. Might an NDPS conclude that diverting resources to tackle upstream causes of ill health is the wisest course of action?

There would need to be name changes. The DHSC would become DSSC – the Department for Sickness and Social Care. Conversely, the DWP would become DWPH, the Department for Work, Pensions and Health. Defra would gain a yuppyish inflection, Defrah – the Department for Environment, Food, Rural Affairs and Health – while the Department for Transport would develop a lisp: DfTH. You get the drift. Then we might finally be on our way to creating a healthier society – and constraining the escalating budget for the National Sickness Service to boot.

[See also: Labour’s missions are no substitute for ideology]