Dear Chancellor-in-Waiting

Dear Chancellor-in-Waiting


2.5 min

You tell us that the NHS, social care, prevention and reducing inequality are all in your sights. So far so good. And you tell us you will finance it all through chasing £5 billion of unpaid tax. Good luck with that! You and your secretary of State for Health- in- waiting insist that the money must come with system reform. I’m with you on that too. Yet why are you wedded to private sector use as the only major reform needed?  Especially when it has already done so much damage. It is an NHS predator that sucks NHS trained hospital consultants away from our service. And when the private sector can't cope with postoperative complications they send their private patients straight back to the NHS. This is unsafe and makes no sense.  Perhaps better to take a cooler look at the evidence. Especially as BBC's Panorama has shown that the quality of care in some parts of the private sector is pretty worrying.

I understand that the huge backlog of waiting patients needs to be reduced. But maybe that backlog needs first to be reviewed for evidence of better practice in other countries.  Maybe waiting by the clock is not the fairest way to manage waiting lists. If you asked NICE to conduct such a review you'd get an evidence based answer, uncontaminated by politics. They could also advise on whether it is equitable to prioritise cancers over other life-threatening conditions too. This could be worth doing as long as NICE can speed up its deliberations. I know that the private sector beckons with its grossly inefficient numbers of empty beds. But there surely must be other models of intervention for the 21st century. Maybe you could create a clear, short term,  cut-off point after which private sector use will be stopped.  Whilst some of the last government's backlog is cleared, It might help if you also developed and funded a more innovative NHS model for dealing with simple procedures in the future. 

If you put your longsighted glasses on you’d see that this copying the short termism of the current government is hardly the best way forward.  

What about the reforms that could make a real difference to health? It is the underpants of government that need to change if we are also able to take those longer term steps on health and the health divide that are  waiting in the wings.  How will you reform government so that your long term plans will survive in an unstable world? Will you agree to work with other political parties in the next pandemic to avoid management by ideology?  How will your plans for devolving power and money to the regions benefit health? And  will you loosen the stranglehold of centralised government quickly so that local frontline health professionals can work effectively with their communities? And when will public health and local authority finances be restored to allow health to catch up?

In a democracy, the electorate has a right to expect your commitment to real reform, rather than more of the same.