Like it or hate it, the NHS is here to stay – BBC News

England has a love-hate relationship with the NHS.

But we still love it. As much as 90% of people agree that this service should be free and available to everyone.

But with more than seven million people on the waiting list, nearly everyone knows someone who isn’t getting the care they need.

As the NHS approaches its 75th anniversary, politicians have fallen over to applaud the service.

But when the cameras aren’t rolling, the message you hear can be very different. Just like us, politicians have a love-hate relationship with the NHS.

“The whole system is crashing and not improving – all progress is going backwards.” It’s not something you might hear from a minister in public, but it’s an honest decision from a former health minister speaking privately.

They said the NHS chief executive had become a “rational leader” tasked with “spreading the bottleneck ever thinner” as demand for treatment raced against what was available.

Another former Conservative minister told me that “The National Health Service is an oxymoron”, a contradiction in terms, because “leadership is highly unequal and outcomes are mixed”.

For Labour, a source said there was increasing “anxiety and danger” about the future of the service and “it’s really a matter of change or death”.

You’d be hard pressed to find a politician who will admit that services are being rationed but in off-the-record conversations the word comes up time and time again.

One former minister said “people have to understand that there is a rationing according to waiting” – saying it was a “trade-off” with the traditional model.

A former government adviser said “people know there are rationing – the service is pretty good when you get it – but you might not”.

You won’t find health rationing in any political flyers or Facebook ads.

But public engagement with the concept of the NHS remains very strong. Before and after the pandemic, voters were in no mood to have discussions about changing their core principles — despite all the issues.

Former government health advisers tell me that any serious conversations about fundamental change are nearly impossible.

“Any sophisticated Tory politician knows they will sign their own death warrant” if they raise the prospect of sweeping change, they say.

Remember Prime Minister Rishi Sunak’s proposal to fine patients if they missed doctor’s appointments? It was discarded as soon as suggested.

Another former official described the public’s strong emotional connection to the idea of ​​the institution itself, saying: “It’s like your family. I’d moan and moan about it, but if anyone from the outside tried it, I’d give them a toast. It’s like criticizing your football team – they can get mad!”

Many politicians are talking about service reform – whether it’s working with the private sector or this week’s workforce plan. But whether it’s necessary or not, it’s almost unthinkable now that any mainstream politician would be arguing for sweeping system-wide changes.

Of course, that has an impact on what governments choose to try and improve services, which may not be the most effective long-term focus.

One former official suggested: “Politicians want solutions with easy metrics like cutting waiting lists.

“If you stop it in the short term, it means more operations, it doesn’t stop people from getting sick in the first place.”

A former minister said rather than undertake bold reforms after the pandemic “we have gone straight back to voodoo land with useless heroic commitments that will never be fulfilled because as a country we are very sick”.

Others suggest ministers are actually afraid to tell the hard truth to the public about increasing cost pressures in healthcare. “People have unrealistic expectations of what we can deliver – the government is afraid of that,” they said.

And as we’ve talked about many times here and on the show, unless and until governments confront painful gaps in caring for the elderly and vulnerable, other health services will have to suffer the costly consequences of social care systems that are largely out of work. .

One former minister I spoke to was deeply frustrated that it was so difficult to speak fully of the NHS, saying that “it’s a political issue, not a resource issue. Our politicians don’t find space” to talk about such bold changes.

One former adviser agreed, saying “everyone of all walks of life was scared to take it”.

But the fact that politicians find it almost impossible to talk about alternatives is also a credit to the longevity of the NHS and the public’s trust in it.

The former adviser suggests that while people will have to wait and results vary “as a system it is unbelievably fair and it has to be worth something”.

Love it and hate it. It is definitely here to stay.