There’s a dilemma at the heart of the NHS – but politicians don’t want to talk about it | Adam Boulton
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
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‘I have used independent health care in past’
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.
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‘I couldn’t believe what I was seeing’
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”.
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Health Secretary Aneurin Bevan launched the NHS in 1948
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.
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‘Nothing has changed!’
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.
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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.
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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.
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Health check for the NHS
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
Russian forces creep through disused gas pipeline in attempt to launch surprise attack on Ukrainian soldiers
Russian special forces crept through a disused gas pipeline for several miles to launch a surprise attack on Ukrainian soldiers in the Kursk region, Ukraine’s military and pro-Moscow war bloggers have said.
Footage circulating on the Telegram app claims to show the elite soldiers crouching as they make their way through the darkness of the pipe to the town of Sudzha.
Some can be heard cursing in Russian and complaining about the commanders who sent them on the mission.
One of the soldiers is heard saying: “F*****g hell, where the f*** are we, boys?”
Another says: “Where does the pipe go? To Sudzha, for f**** sake, that’s f***ing crazy.”
Later in the clip a soldier is heard saying: “We’ll get there of course, but indignantly, because we’re f*****g sick of the f*****g command.”
He later adds: “They took our f*****g assault rifles too.”
Two of the soldiers are seen smoking cigarettes while a separate image shared on Telegram shows an operative wearing a gas mask.
The footage shows soldiers creeping through the pipeline
Soldiers are seen smoking cigarettes
The special forces soldiers walked around nine miles (15km) through the pipeline which Moscow had until recently used to send gas to Europe, according to Telegram posts by Ukrainian-born pro-Kremlin blogger Yuri Podolyaka.
In the footage, the soldiers suggest the mission requires them to walk seven miles through the pipe.
Mr Podolyaka says some of them spent several days in the pipeline before striking Ukrainian units from the rear near Sudzha.
The operation formed part of efforts by Russia to recapture areas of Kursk which were seized by thousands of Ukrainian soldiers in a shock offensive in August last year.
Another pro-Russian war blogger, who uses the alias Two Majors, said a major battle is under way in Sudzha after Moscow’s special forces crept through the pipe.
Meanwhile, Ukraine’s general staff confirmed on Saturday that Russian soldiers had used the pipeline in an attempt to gain a foothold, but airborne assault forces promptly detected them, and they responded with rocket, artillery and drone attacks that destroyed Moscow’s units.
“The enemy’s losses in Sudzha are very high,” the general staff reported.
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A close-up image of one of the soldiers in the pipeline
The soldiers crept through the tunnel for several miles
It comes as Ukraine’s Air Assault Forces shared a video on Telegram on Saturday which it claims shows Kyiv’s forces repelling Russian forces in Kursk with airstrikes.
Sky News has not independently verified the footage.
Months after Kyiv’s forces seized parts of Kursk, Ukrainian soldiers are weary and bloodied by relentless assaults of more than 50,000 Russian troops, including some from Moscow’s ally North Korea.
Tens of thousands of Ukrainian soldiers run the risk of being encircled, open-source maps of the battlefield showed on Friday.
Meanwhile, Russia’s defence ministry said this morning that it had captured a settlement in Kursk and another in Ukraine’s Sumy region.
Russia also launched heavy aerial attacks overnight on Ukraine into Saturday – with at least 22 people killed, including 11 in the frontline town of Dobropilla in Ukraine’s embattled eastern Donetsk region.
Ukrainian president Voldymyr Zelenskyy described the attacks as a “vile and inhumane intimidation tactic” by Russia.
The attacks come after the US paused military aid and the sharing of intelligence with Ukraine this month after a meeting between US President Donald Trump and Mr Zelenskyy descended into a confrontation in front of the world’s media.
The Trump administration’s stance on Ukraine and apparent favouring of Moscow has sparked concern among European leaders.
Latvian President Edgars Rinkevics told Sky News on Sunday that European countries should “absolutely” introduce conscription as he conceded the continent was “quite weak” militarily in the face of the Russia threat.
Meanwhile, Russian officials have been criticised after presenting mothers of soldiers killed in Ukraine with gifts of meat grinders on International Women’s Day.
Russia is often accused of throwing its troops into a “meat grinder” with little regard for their lives.
The local branch of government in the northwestern Russian town of Polyarniye Zori defended itself against the backlash, saying critics were making “callous and provocative interpretations” of the gifts.
Canada is set for a new prime minister as the ruling Liberal Party prepares to announce Justin Trudeau’s replacement as leader.
Mr Trudeau, who has been prime minister since 2015, announced he was stepping down in January after facing calls to quit from a chorus of his own MPs.
The 53-year-old’s popularity had declined as food and house prices rose.
The Liberal Party will announce its new leader tonight following a vote by around 140,000 members.
A former Bank of England governor has emerged as the frontrunner as the country deals with the impacts of tariffs imposed by US President Donald Trump.
The next prime minister will also have to decide when to call a general election – which must be held on or before 20 October.
As the Liberal Party prepares to choose its new leader, we take a look at the candidates.
Mark Carney
Mark Carney addresses supporters in Alberta in March. Pic: AP
The 59-year-old will be a familiar face to many in the UK as he served as governor of the Bank of England between 2013 and 2020.
He was formerly the head of Canada’s central bank and was praised after the country recovered from the 2008 financial crisis faster than many other countries.
Mr Carney has picked up one endorsement after another from cabinet ministers and MPs since he declared his candidacy in January.
He did not serve in Mr Trudeau’s government but was named as the chair of a government task force on economic growth last September.
Daniel Beland, a political science professor at McGill University in Montreal, said Mr Carney’s calm demeanour and outstanding resume make him a reassuring figure to many Canadians at a time when Mr Trump is “going after their country’s economy and sovereignty”.
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Chrystia Freeland
Chrystia Freeland speaks during the Liberal leadership debate in Montreal in February. Pic: AP
Ms Freeland, a former deputy prime minister and finance minister of Canada, was leading in the polls to replace Mr Trudeau shortly after he announced his resignation.
However, her long association with the outgoing prime minister and the threat of Mr Trump’s tariffs have since tipped things in Mr Carney’s favour.
The 56-year-old was born in the west Canadian province of Alberta to a Ukrainian mother.
Before entering politics in 2013, Ms Freeland worked as a journalist covering Russia and Ukraine for several years.
Mr Trudeau told Ms Freeland that he no longer wanted her as finance minister in December but that she could remain deputy prime minister and the point person for US-Canada relations.
She stepped down shortly after and released a scathing letter about the government which increased pressure on Mr Trudeau ahead of his resignation.
Karina Gould
Karina Gould speaks during the Liberal Party leadership debate in Montreal in February. Pic: AP
Ms Gould is the youngest woman to serve as a minister in Canada and has advocated for a tough stance on Mr Trump.
The 37-year-old, who has served as minister of democratic institutions and minister of international development, has previously branded herself as part of a “generational shift” and said the Liberal Party “needs to embrace this shift too”.
Ms Gould has reportedly proposed an increase in corporate taxes on large companies earning more than CAN$500m (£270m) a year to encourage them to reinvest in business and productivity.
She was serving as house leader until January 2025 when she left the cabinet to run for party leader.
Frank Baylis
Frank Baylis during the Liberal Leadership debate in Montreal in February. Pic: AP
Mr Baylis, a businessman from Montreal, served as a Liberal Party politician between 2015 and 2019.
The 62-year-old has reportedly proposed creating two pipelines that would transport natural gas to international markets in Europe and Asia to reduce dependence on America.
Mr Baylis criticised Mr Trudeau for travelling to meet Mr Trump at his Mar-a-Lago resort in November.
He said: “Anybody’s that ever dealt with a bully successfully know you don’t give an inch.”
What’s next for Canada?
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‘You can’t take our country or our game’
The new leader of the Liberal Party is expected to call a general election shortly after they take up the role.
After decades of bilateral stability, Canada’s next election is expected to focus on who is best equipped to deal with the United States.
Mr Trump’s trade war and his talk of making the country the 51st state have infuriated Canadians, who are booing the American anthem at NHL and NBA games.
Some are cancelling trips south and many are avoiding buying American goods when they can.
Pierre Poilievre, the leader of the main opposition Conservative Party, has embraced a populist approach not unlike Mr Trump’s.
He attacks the mainstream media and has vowed to put “Canada First”.
Before Mr Trump’s inauguration, the Conservatives were widely expected to win the country’s next election.
However, the US president’s threats against Canada have led to a surge in popularity for the Liberal Party in the polls.
World
Zelenskyy condemns ‘vile and inhumane’ Russian attacks after one of year’s deadliest days for Ukrainian civilians
Volodymyr Zelenskyy has thanked Ukraine’s allies for condemning Russian strikes after one of the deadliest days for civilians in his country so far this year.
Ukraine’s president described the attacks as a “vile and inhumane intimidation tactic” by Russia.
While a warning by Donald Trump to Vladimir Putin to stop “pounding” Ukraine or else, appears to have fallen on deaf ears.
Russia launched heavy aerial attacks overnight into Saturday after the White House administration suspended intelligence sharing with Ukraine.
The US has been piling pressure on President Zelenskyy’s government to cooperate in convening peace talks with Russia.
American aerospace company Maxar Technologies said on Friday it had disabled access to its satellite imagery for Kyiv. Its ability to strike inside Russia and defend itself from bombardment is very much diminished without such images.
At least 22 people were killed in multiple Russian attacks, including 11 in the frontline town of Dobropilla in Ukraine’s embattled eastern Donetsk region.
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Russian strike kills at least 11 in Ukraine
Russia fired two ballistic missiles into the town centre, then launched a strike targeting rescuers who responded, according to Mr Zelenskyy. Forty-seven people, including seven children, were injured in the attack.
“It is a vile and inhumane intimidation tactic to which the Russians often resort,” he said.
The president added: “It was one of the most brutal strikes, a combined one. The strike was deliberately calculated to cause maximum damage. Missiles, along with a Shahed drone, targeted the central part of the town.
“Nine residential buildings were hit. Also, the shopping centre and stores were struck.”
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People stand at the site of an apartment building hit by a Russian missile strike in Dobropillia. Pic: Reuters
Another seven people were killed in four towns close to the frontline where Russian troops have been making steady advances, said regional governor Vadym Filashkin.
Three others died when a Russian drone hit a civilian workshop in the northeastern Kharkiv region, emergency services reported. And one man was killed by shelling in the region.
The UN Human Rights Monitoring Mission in Ukraine said it was one of 2025’s deadliest attacks for Ukrainian civilians.
Pic: Reuters
Some 24 hours earlier, Russia struck Ukrainian energy facilities using dozens of missiles and drones.
The attacks hampered Ukraine’s ability to supply power to its citizens and run weapons factories vital to its defences.
When asked on Friday if Russian President Vladimir Putin was taking advantage of the US pause on intelligence-sharing to attack Ukraine, Mr Trump responded: “I think he’s doing what anybody else would.”
Mr Zelenskyy did not mention intelligence-sharing on Saturday, but said he welcomed Mr Trump’s proposal to bring in banking sanctions and tariffs on Russia until a ceasefire and final peace settlement is reached.
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Mr Zelenskyy also said: “I am grateful to all the leaders, all those diplomats of our partner countries, all public figures who support Ukraine, who have condemned these Russian strikes and who call all things by their proper names.
“And it is essential that we continue coordinating all our efforts with our partners to ensure that our defence works effectively and that we do everything to bring peace closer.”
Mr Zelenskyy has said he and other senior Ukrainian officials will go to Saudi Arabia next week to discuss proposals aimed at ending the war.
In a post on X, he wrote he was set to meet Saudi Arabia’s Crown Prince Mohammed bin Salman on Monday, and his team would remain in the country to have talks with US officials.
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