There’s a dilemma at the heart of the NHS – but politicians don’t want to talk about it | Adam Boulton

Published

2 years ago

January 13, 2023

admin

Margaret Thatcher’s sometime chancellor Nigel Lawson famously remarked that the NHS is “the closest thing the English people have to a religion”.

Certainly, as the UK census records a decline in adherence to Christianity, celebrating and bemoaning the state of “our NHS” brings together citizens of all creeds and political persuasions.

Everyone fears pain and sickness. The aspiration of those who set up the NHS was to divorce those real concerns from worries about money and being able to pay for care.

The NHS was to be paid for through taxation, making all treatment “free at the point of delivery”.

For many people, the idea that health care should not be paid for by the individual has become an article of faith.

This week, the inference that he’d gone against this rule provided an effective line of attack against the prime minister, who also happens to be a multimillionaire.

After days of challenge from the media and political opponents, Rishi Sunak finally confessed at PMQs that he had “used independent health care in the past”, while protesting “I am registered with a NHS GP”.

If you are an NHS worker and would like to share your experiences with us anonymously, please email NHSstories@sky.uk

What does ‘free’ really mean?

In reality, the divide between “free”, taxpayer-funded health care, and good, private medicine is nowhere near as clear-cut as Mr Sunak‘s awkward moments would suggest.

The majority of NHS users actually make some sort of personal “co-payment” for services, every time they pick up a prescription.

According to the Office of National Statistics, at least 13% of adults paid for private medical care in the last year.

And just to keep up with present inadequate levels of treatment, the NHS itself is heavily reliant on contracting workers and services from the private sector.

When the NHS was established in 1948, the official leaflet sent out to all households spelt out its core principles.

“Everyone – rich or poor, man, woman or child – can use it or any part of it,” it said.

“There are no charges, except for a few items. There are no insurance qualifications. But it is not a ‘charity’. You are all paying for it, mainly as taxpayers, and it will relieve your money worries in time of illness.”

From the start, that sidebar phrase “except for a few items” gave away that not everything would be absolutely free.

Some services would require some payments by some patients.

Nye Bevan, the minister who launched the NHS, resigned from the Labour government when charges were introduced for “teeth and specs” – dental treatment, dentures, glasses and surgical appliances.

A few years later, a Conservative government introduced prescription charges. All these still apply today, even as the cost of health care for the nation has multiplied 10 times over.

The NHS budget in 1948 was £437m – the equivalent of some £16bn in today’s money.

The NHS budget for 2023-24 has been set at £160.4bn, subject to any subsequent emergency funding to deal with strikes and the “health care crisis”.

From GPs to social care, NHS setup is full of anomalies

There are further anomalies in the way the NHS is set up: family doctors are supposed to be the gateway to treatment in the NHS – but GPs stayed out of the system. Their practices are self-employed small businesses, while in hospitals; doctors, nurses, and technicians are employed by the NHS.

Technically, taxpayers don’t pay directly to the NHS, but contribute to the budget for “health and social care services”.

But social care – looking after people who need it at home or in care homes – was excluded from the “free” principle and consequently underfunded.

With a growing proportion of elderly people in the population, the absence of properly funded care has resulted in alleged “bed blocking” at hospitals and inadequate pay for care workers compared to those doing a similar job in the health service.

Attempts by various governments to find ways for families to contribute more to the cost of care backfired. In 2017, Theresa May’s care proposals were quickly dubbed the “dementia tax”. An earlier plan from Labour was branded the “death tax” by Tory finance spokesman George Osborne.

In the meantime, more than seven million people are on waiting lists for NHS treatment.

Waiting times are mounting in A&E departments and for ambulances delivering patients to hospitals. Britain’s “excess deaths” are running significantly above the average.

Once again, the relationship between the NHS and private health care is being seen as a solution by some and a problem by others.

Some NHS hospital trusts are buying operations for their patients in private hospitals – or even in French hospitals.

The government is planning to “buy” beds in care homes to get people out of hospitals.

On the other hand, some trusts are telling those on waiting lists that they can get their operations quickly if they go private – often using facilities in the same hospital, with the same NHS staff moonlighting.

Statistics suggest that overall delivery by NHS services was best during the early years of this century, after Tony Blair and Gordon Brown raised funding for the NHS to the European average for health care spending per capita.

Since then, the UK has dropped behind again.

Using OECD data, the King’s Fund reported that compared to most of the rest of the Western world, the UK has one of the lowest numbers of doctors, nurses, and hospital beds for the size of its population.

Will the public pay more?

Argument continues over whether it is lack of funding or inefficient bureaucratic organisation which is responsible for the NHS crisis.

The public’s belief that health care should be “free” is not making a solution any easier. Opinion polls show public sympathy for the pay claims of nurses, doctors, and paramedics and for paying more for the NHS.

But this generous spirit does not extend very far in practice.

In a detailed survey by Redford and Wilton Strategies, asking “how much more in tax would the British public be prepared to pay to provide more funding to the NHS”, 43% said they would pay nothing more, and 24% set the maximum extra at £100. Only 11% said they would pay upwards of £500.

Does Labour have a serious solution?

Labour says the extensive “NHS Plan” outlined by Sir Keir Starmer and Wes Streeting would be paid by ending non-dom status and without troubling most UK taxpayers.

This is highly ambitious since Labour proposes ending staff shortages by doubling the number of medical school places and of district nurses; 10,000 extra nurses and midwives each year and 5,000 more health visitors.

Nor is it clear how these long-term supply side measures would “end the Tory crisis”, as Sir Keir claims.

In its 75-year history, the NHS has been managed by both Labour and Conservative governments, and they have confronted the same challenges.

True, in most years since the 2008 banking crisis the NHS has been funded at below the average 4% annual increase it had come to expect since the 1950s.

But in that time, funding levels were never a major point of difference between the parties.

Behind the rhetoric, the latest attempts to sort out the NHS are cross-party.

The government has appointed Patricia Hewitt, a former Labour health secretary, to conduct a review of the new integrated care boards. Both parties are developing long-term training programmes to end staffing shortages.

But the “free” NHS is so popular that politicians shy away from questioning its core principles and organisation, even though health care needs and available treatments are vastly different from those in 1948.

Voters want more and more without having to pay more for it. Rather than confront patients or health professionals with this dilemma, it’s easier to polish old grievances and indulge in a shouting match about those, including Mr Sunak, who can pay for health care bypassing the NHS which others cannot afford.

World

UAE says navigational error caused oil tankers to collide near Strait of Hormuz

Published

22 mins ago

June 19, 2025

admin

UAE says navigational error caused oil tankers to collide near Strait of Hormuz

A crash between two oil tankers on a major shipping route near the UAE was likely caused by a navigational misjudgement by one of the vessels, officials have said.

The Adalynn and Front Eagle tankers collided and caught on fire on Tuesday near the Strait of Hormuz, a narrow channel which connects the Persian Gulf to the Gulf of Oman.

Israel-Iran latest: Tehran warns US against intervention

In a statement issued today, the United Arab Emirates’ energy ministry did not draw any link between the crash and an upsurge in electronic interference amid the Israel-Iran conflict.

Interference has disrupted navigation systems near the strait since the two countries began firing missiles at each other last week.

The multinational US-led Combined Maritime Force’s Joint Maritime Information Centre said in an advisory this week that it had received reports of interference stemming from near Iran’s Port of Bandar Abbas and other areas in the Gulf region.

Tehran has not commented on the collision or reports of interference.

The UAE coastguard said it evacuated 24 people from the Adalynn, while personnel on Front Eagle were reported safe with no pollution visible after a fire on its deck.

The Strait of Hormuz – which handles around a fifth of the world’s seaborne oil – links the Gulf to the northwest with the Gulf of Oman, the Arabian Sea beyond.

The Adalynn, owned by a company based in India, had no cargo and was sailing towards the Suez Canal in Egypt, according to monitoring service TankerTrackers.com.

The Front Eagle was on its way to Zhoushan in China – and loaded with two million barrels of Iraqi crude oil, the tracker said.

TankerTrackers.com said on X that the Front Eagle was moving southbound at a speed of 13.1 knots when it “executed a starboard [right] turn, resulting in a collision” with the Adalynn.

The exact cause of the collision, which resulted in no injuries or spills, is still unclear.

World

US President Donald Trump says he ‘may or may not’ strike Iran as Israel’s air war continues

Published

3 hours ago

June 19, 2025

admin

US President Donald Trump says he 'may or may not' strike Iran as Israel's air war continues

US President Donald Trump says he has yet to decide whether the US will join Israel militarily in its campaign against Iran.

Asked whether the US was getting closer to striking Iran’s nuclear facilities, Mr Trump said: “I may do it. I may not do it.”

Speaking outside the White House on Wednesday, he added: “Nobody knows what I’m going to do…Iran’s got a lot of trouble, and they want to negotiate.

“And I said, ‘why didn’t you negotiate with me before all this death and destruction?'”

Mr Trump said Iran had reached out to W ashington, a claim Tehran denied, with Iran’s mission to the UN responding: “No Iranian official has ever asked to grovel at the gates of the White House.”

Iran’s supreme leader, Ayatollah Ali Khamenei said Iran would not surrender and warned “any US military intervention will undoubtedly cause irreparable damage” to US-Iranian relations.

World

UK attorney general ‘has questions’ on legality of Israel’s actions in Iran

Published

3 hours ago

June 19, 2025

admin

UK attorney general 'has questions' on legality of Israel's actions in Iran

The UK government’s top legal adviser has raised questions over whether Israel’s actions in Iran are lawful, according to a source familiar with discussions inside the government.

The source suggested to Sky News that Attorney General Richard Hermer’s thinking, which has not been published, complicates the UK’s potential involvement in the Iran-Israel conflict.

If the attorney general deems Israel’s actions in Iran to be unlawful then the UK is restricted in its ability to help to defend Israel or support the United States in any planned attacks on Iran.

Speaking on condition of anonymity, the source said that the attorney general’s concerns limit UK involvement in the conflict “unless our personnel are targeted”.

US President Donald Trump is currently weighing up his options for Iran and has repeatedly suggested the US could get involved militarily.

This would likely involve the use of US B-2 bombers to drop bunker-busting bombs to destroy Iran’s nuclear facility built deep into the side of a mountain at Fordow.

These B-2 bombers could be flown from the UK base at Diego Garcia in the Indian Ocean, strategically close to Iran.

The US could also choose to fly them the far greater distance from the US mainland.

Under a long-standing convention, the UK grants permission to the US for the base to be used for military operations.

The US military could also request the use of the UK military base in Cyprus, for refuelling planes.

Any refusal by the British could complicate US military action and, diplomatically, put pressure on the trans-Atlantic relationship.

Israel’s justification

Israel has justified its war by claiming that Iran poses an “imminent” and “existential” threat to Israel.

Prime Minister Benjamin Netanyahu has cited his country’s own undisclosed intelligence claiming Iran was on the brink of obtaining a nuclear weapon.

The Israeli government also claimed, without publishing evidence, that Iran was planning an imminent attack on Israel.

They also cited the recent International Atomic Energy Agency (IAEA) report which concluded that Iran had been “less than satisfactory” in “a number of respects” on its international compliance over its nuclear activities.

It is not clear what aspect of Israel’s justification for military action the attorney general has concerns over.

The Attorney General’s Office has told Sky News: “By long-standing convention, reflected in the ministerial code, whether the law officers have been asked to provide legal advice and the content of any advice is not routinely disclosed.

“The convention provides the fullest guarantee that government business will be conducted at all times in light of thorough and candid legal advice.”

The UK armed forces have previously rallied to help defend Israel from Iranian missile and drone strikes when the two sides engaged in direct confrontation last year.

In April 2024, RAF typhoon jets shot down drones fired from Iran.

The UK military was also involved in efforts to defend Israel from a ballistic missile attack in October 2024.

But the UK has not been involved in the current conflict, which began when Israel targeted Iranian nuclear facilities and scientists as well as more definitive military targets such as missile launchers and commanders.

The UN’s nuclear watchdog has previously raised concerns about any attack against nuclear facilities because of the inherent danger but also the legality.

A number of resolutions passed by the IAEA’s general conference has said “any armed attack on and threat against nuclear facilities devoted to peaceful purposes constitutes a violation of the principles of the United Nations Charter, international law and the Statute of the Agency”.

Israel believes that Iran’s nuclear programme has a military use, which makes it a legitimate target.

It believes the regime is aimed to enrich uranium to develop nuclear weapons.

Tehran, however, has always insisted its nuclear programme is for civilian use.

The International Commission of Jurists (ICJ) has also condemned Israel’s use of armed force against Iran as a violation of the United Nations (UN) Charter and international law.

Interpretations of International Law

Different countries adopt varying interpretations on the use of force in response to future attacks.

The first legal position is that nations can act preventatively to deflect threats.

The second is that they can act to deflect future armed attacks that are imminent.

The third is that states can only act to deflect attacks that have occurred.

That third position is generally considered to be too restrictive and the first as too broad.

The grey area lies with the second position, and it rests with the definition of “imminent”.

The concepts of “proportionality”, “necessity” and “imminence” are key considerations.

International law scholars have told Sky News that Israel may pass the “proportionality” test in its actions against Iran because its targets appear to have been military and nuclear.

But whether there was the “necessity” to attack Iran at this point is more questionable.

The attorney general would likely be considering the key legal test of the ‘imminence’ of the Iranian threat against Israel – and whether it is reasonable to conclude that an attack from Iran was “imminent” – as he weighs the legal advice issued to UK Prime Minister Sir Keir Starmer.

There is always nuance with legal advice, judgements rest on a variety of factors and advice can evolve.

In the run up to the 2003 Gulf War, the US and UK justified their action by arguing that Saddam Hussein possessed Weapons of Mass Destruction – a claim that turned out to be wrong.

The then-attorney general’s advice, which evolved, was central to Tony Blair’s decision to join President Bush in attacking Iraq.