The NHS can be reformed, but not by rationing and endless waits

The National Health Service is no longer able to give patients what they need, let alone what they might want. This has been made painfully clear by NHS chief Simon Stevens, whose blueprint to save his organisation combines fluffy symbolism – cracking down on sunscreen prescriptions – with rationing, such as the admission yesterday that waiting time targets for routine operations will be scrapped.

The NHS cannot continue as it is. But still no real solutions are on offer. Here are four: 1. More efficiency savings. The crackdown on prescriptions is an overdue first step, but the £128 million expected is the tip of the iceberg. In 2010, the OECD ranked the UK third-highest for potential savings from greater efficiency.

This is in large part due to the fact that during the first 10 years of this century, the NHS became flush with cash for its “inputs”, not for its “outputs”. In other words, most of the money went, according to the National Audit Office, to “funding higher staff pay and increases in head count”, not on patient need. 2. Offer patients the choice they were promised. British patients supposedly get to pick their provider of choice at the point of referral. In practice, only one in three are offered this by their GP. The OECD ranks the UK “below average” compared with countries with similar systems such as Norway, where decentralisation and greater use of private providers create the competition needed to give patients decent options. 3. Begin the transfer to a social insurance system. For most healthcare systems in the developed world, perpetual crisis is not the norm. In Belgium and the Netherlands you can be seen in A&E in less than an hour, and get a GP appointment on the same day.

It’s estimated that 9,000 and 14,000 lives respectively would be saved each year if British patients with the five most common types of cancer were treated in those countries, instead of here. The UK’s stepping stone to a better system could be through Clinical Commissioning Groups, which are in some ways comparable to insurers; giving people free choice of CCG would be far better than Stevens’s proposal of wait-time rationing. 4. Stop worshipping those three little letters. There is nothing unique about the NHS. Almost all developed countries offer full access to healthcare, regardless of ability to pay. “Our NHS” makes it sound like the nation’s adopted puppy. It’s not – it’s a healthcare system. Let’s save our praise for the doctors and nurses who are trying to put patients first in a system that’s rigged to prevent them for doing just that.

Next time he launches a plan to save the NHS, Stevens needs to consider real reform. Rollbacks and rationing just aren’t good enough.

Kate Andrews is news editor at the Institute of Economic Affairs