Is it time to give up on the NHS, our national religion?

Sajid Javid makes an unlikely Martin Luther, nailing his theses to the door of a London think tank, calling for a Reformation in the national religion. He was health secretary for only 12 months in the vaccination phase of the coronavirus crisis, but it was long enough for him to think deeply about whether the NHS model was the right one.

As a heretic, he knows that there will be some resistance from the faithful to the message that we can learn something from the way they do things on the continent — which is why he starts his foreword to the Policy Exchange report calling for the abolition of the NHS by claiming that this is the way to restore the health service to its founding principles. Just as Luther argued that Christianity was basically the right idea, Javid says that “while the strength of our belief in these ideals has not wavered, our ability to deliver them is increasingly being called into question”.

And, just like Luther, Javid says that he and Policy Exchange are simply proposing questions to be debated. But when Javid says the choice is between “putting more and more money into healthcare, funded by yearly tax rises and by diverting essential investment into everything from education to defence towards the NHS” and “reforming how we do healthcare”, it is clear what his preference is.

The timing of Javid’s defiance is interesting. With hospital doctors losing the support of the public, Wes Streeting, Javid’s successor, warned recently that strikes would be “a gift to Nigel Farage”. Streeting argued that the strikes will undermine respect for doctors and weaken support for the idea of the NHS — and “if Labour fail”, he said, Farage will point to that as “proof that the NHS has failed and must now be replaced by an insurance-style system”.

This is where the argument becomes complicated. Drawing dividing lines between Labour and Reform is the Keir Starmer plan to win a second term. The prime minister wants to force Lib Dems, Greens, soft Tories and people who like the NHS to choose between him and Farage at the next election. It is not a terrible strategy: there are lots of voters who are deeply disappointed with the Labour government, but who regard Farage as the electoral equivalent of Satan.

The complication is that Farage has tried to renounce his support for a French-style social insurance model of healthcare. He is aware that the NHS is popular, and that anyone proposing to abolish it will be excommunicated. So his manifesto last year promised a reformed NHS, “still free at the point of delivery”. But Farage went on TV during the campaign to say that he wanted a healthcare system like that in France, “as if it was a private company”. This year, he said he was “fully, fully aware” that the French system is not completely free at the point of use: “I’m not saying we should absolutely mimic the French system ... Let’s have a think about how we do things.”

The best that can be said about Reform’s policy is that it is not entirely clear.

That is probably why it has to be left to former politicians such as Javid to make the argument for change. The Policy Exchange report makes a powerful case, pointing out that the Dutch moved to a social insurance system recently: “In 2006, the Netherlands radically reshaped its healthcare system to involve more competition and greater consumer choice. The reform has been extremely successful and Dutch healthcare costs are proportionately lower than the UK, waiting lists lower and health outcomes generally better.”

What is critically important, as Javid argues, is that the money has to come from somewhere, and a social insurance system shares the cost between the patient and the taxpayer — stating that patients should pay £20 for a GP appointment, for example. This would allow more to be spent overall, more efficiently, and it would protect the budget to some extent from short-term political pressures. We are probably a long way from such a model being acceptable to the British people, but Streeting is right to argue that doctors’ strikes will take them a step closer to the unthinkable. It was Nigel Lawson, the Conservative chancellor, who said in his 1992 autobiography, subtitled Memoirs of a Tory Radical, that “the National Health Service is the closest thing the English have to a religion” — but the rest of that sentence was also significant: “... with those who practise in it regarding themselves as a priesthood”.