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.
Virginia Giuffre, who accused Prince Andrew of sexual assault, has died aged 41.
In a statement to Sky’s US partner network NBC News on Friday, her family said she took her own life in Neergabby, Australia, where she had been living for several years.
“It is with utterly broken hearts that we announce that Virginia passed away last night at her farm in Western Australia,” her family said.
“She lost her life to suicide, after being a lifelong victim of sexual abuse and sex trafficking.
“Virginia was a fierce warrior in the fight against sexual abuse and sex trafficking. She was the light that lifted so many survivors.
“In the end, the toll of abuse is so heavy that it became unbearable for Virginia to handle its weight.”
Ms Giuffre sued the Duke of York for sexual abuse in August 2021, saying Andrew had sex with her when she was 17 and had been trafficked by his friend, the billionaire paedophile Jeffrey Epstein.
The duke has repeatedly denied the claims, and he has not been charged with any criminal offences.
In March 2022, it was announced Ms Giuffre and Andrew had reached an out-of-court settlement – believed to include a “substantial donation to Ms Giuffre’s charity in support of victims’ rights”.
Prince Andrew has denied all claims of wrongdoing. File pic: Reuters
‘An incredible champion’
Sigrid McCawley, Ms Giuffre’s attorney, told NBC News that she “was much more than a client to me; she was a dear friend and an incredible champion for other victims”.
“Her courage pushed me to fight harder, and her strength was awe-inspiring,” she said. “The world has lost an amazing human being today.”
“Rest in peace, my sweet angel,” she added.
Dini von Mueffling, Giuffre’s representative, also told the outlet: “Virginia was one of the most extraordinary human beings I have ever had the honour to know.
“Deeply loving, wise, and funny, she was a beacon to other survivors and victims. She adored her children and many animals.
“She was always more concerned with me than with herself. I will miss her beyond words. It was the privilege of a lifetime to represent her.”
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Ms Giuffre said at the end of March she had four days to live after a car accident, posting on social media that “I’ve gone into kidney renal failure”. She was discharged from hospital eight days later.
Raised mainly in Florida, she said she was abused by a family friend early in life, which led to her living on the streets at times as a teenager.
She said that in 2000, she met Ghislaine Maxwell, a British socialite who was convicted in 2021 on federal sex trafficking and conspiracy charges and was sentenced to 20 years in prison.
Ms Giuffre said Maxwell then introduced her to Epstein and hired her as his masseuse, and said she was sex trafficked and sexually abused by him and associates around the world.
‘I am now a survivor’
After meeting her husband in 2002, while taking massage training in Thailand at what she said was Epstein’s behest, she moved to Australia and had a family.
She founded the sex trafficking victims’ advocacy charity SOAR in 2015, and is quoted on its website as saying: “I do this for victims everywhere.
“I am no longer the young and vulnerable girl who could be bullied. I am now a survivor, and nobody can ever take that away from me.”
:: Anyone feeling emotionally distressed or suicidal can call Samaritans for help on 116 123 or email jo@samaritans.org in the UK. In the US, call the Samaritans branch in your area or 1 (800) 273-TALK.
World
Fighter jets, a naval destroyer and guns on show: The ‘unprecedented’ security operation for Pope’s funeral
As the line of mourners moves slowly along behind him, Ciriaco Sarnelli peers at me from beneath the immaculate brim of his cap.
The military police chief looks, by any standards, magnificent – shoulders back and proudly wearing the black uniform of the Carabinieri.
“Our history goes back more than 200 years,” he says. “We remember our past, and our place. The only people with black uniforms are the priests, the judges and the Carabinieri.”
He leaves the rest unsaid – the Carabinieri sit at the heart of Italian cultural life.
Ciriaco Sarnelli, Carabinieri military police chief
Pope latest: Security ramping up ahead of funeral
Once, they defended the borders of a young nation. Now, they have a new challenge that has its own weighty burden – to keep St Peter’s Square safe during the funeral of Pope Francis.
This is no easy task. Hundreds of thousands will descend upon the Vatican for the event.
Many of the world’s best-known politicians and dignitaries will be welcomed into St Peter’s Basilica.
Inside will be Donald Trump, Sir Keir Starmer, Joe Biden, Emmanuel Macron, Prince William and dozens upon dozens of other dignitaries.
Outside will be the Carabinieri.
They won’t be alone – there are thousands of other police officers due to be assigned to protect the event – but the Carabinieri are affiliated to the military; the most highly-trained officers on duty.
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A member of the security personnel wields an anti-drone gun for the Pope’s funeral
“This is an extraordinary operation,” says Sarnelli, as we look out over the crowd. “So we have employed some special units that belong to Carabinieri – the bomb squad, a dogs unit, snipers and helicopters. We want to assure the people who are arriving here that they can take part in this event in the best way, in a secure way.”
He says they are ready for “common crimes” – like pickpockets in the crowd – but also “the biggest, terrifying events”.
He says there is “excellent coordination” with police forces from other countries.
Around him, his officers are smiling, chatting to tourists and Romans alike.
The security here is overt but friendly, even if I’m told there are also plenty of plain-clothed officers mingling within the crowd.
Guns and grins both on show.
A police helicopter circles above. In the port of Rome, a naval destroyer has been primed for action; there are fighter jets ready to take off.
You can watch full coverage of the funeral live on Sky News on Saturday
Huge crowds have come from around the world to see the Pope’s body
If the impression is relaxed, the reality is different. The classic swan.
All the strands are pulled together from one place and, what’s more, it offers a perfect view of Vatican City.
From where I’m standing, I can see the front of St Peter’s Basilica, the side, and the roads around it. I can see the crowds coming in, and the crowds going out.
And I can see an anxious policeman drumming his fingers.
But we are not in St Peter’s and not even in the Vatican.
This is the high-security control room on the fifth floor of Rome’s police headquarters.
And from here, you can see everything.
The control room from where security officials can see across the Italian capital
An array of screens are in front of us and, watching them, men and women, huddled over screens and all wearing contrasting uniforms.
Some are military, some national police, some wear the clothes of firefighters. A few are in plain clothes and there is even a man wearing the badge of the prison officers’ service.
This centre is a hub for collaboration and decision-making and it brings together every service that is involved in ensuring the safety and security of the funeral.
There is a Carabinieri officer here, as well as the Guardia di Finanza national police and the Roman force. The government’s secret intelligence service is represented here, too.
Elisabetta Accardo is from Rome’s police department. We talk against the gentle hubbub in the control room, colleagues pointing at screens and agreeing plans.
Elisabetta Accardo, Rome Police control room spokeswoman
I ask when Italy last had to deal with a security operation on this scale, and she laughs. “Hundreds of years,” she says.
“It is unprecedented. The level of security is at the maximum.” She describes the plan as “structured three-dimensional security”.
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It is a plan that has been long in the making, but which has been reshaped over the past few days to react to the whims of the Pope’s final wishes.
It is, after all, more than a century since a pope was buried outside the walls of the Vatican.
You get the impression that the people designing the security plan could rather have done without having to add an hour-long procession through Rome into the plan.
But so be it.
By Saturday night, it will be done. Rome can start to get back to normal; the foreign leaders will be on their way home.
And the Rome police will breathe just a little bit easier.
World
Kremlin blames Ukraine for car bomb killing of Russian general near Moscow – as Trump envoy meets Putin
The Kremlin has blamed Ukraine for a car bomb that killed a Russian general near Moscow hours before Donald Trump’s envoy was due to meet Vladimir Putin in the capital.
The death of Lieutenant General Yaroslav Moskalik is the second such fatal attack on a top Russian military officer in four months.
Russia’s top criminal investigation agency said he was killed by an explosive device placed in his car in Balashikha, just outside the capital.
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Yaroslav Moskalik. Pic: Russian Ministry of Defence
Moskalik was a deputy head of the main operational department in the General Staff of the Russian armed forces.
“The Kyiv regime once again simply shows its true nature. The Kyiv regime continues to be involved in terrorist activity on the territory of our country,” Kremlin spokesman Dmitry Peskov said.
He didn’t offer any evidence.
“It shows once again that, despite the peace talks, we must be on guard and understand the nature of this regime.”
Ukraine has not responded to the killing.
Investigators work at the scene where Lt Gen Yaroslav Moskalik was killed. Pic: AP
Investigative committee spokesperson Svetlana Petrenko said the explosive device was rigged with shrapnel, adding that investigators were at the scene.
Videos showed a vehicle burning in the courtyard of an apartment building and a body covered in a sheet could be seen on the pavement nearby.
It comes after Lieutenant General Igor Kirillov was killed in December when a bomb hidden on an electric scooter parked outside his apartment building exploded as he left for his office.
Russian authorities blamed Ukraine for the killing of Kirillov, and Ukraine’s security agency acknowledged that it was behind that attack.
Kirillov was the chief of Russia’s radiation, biological and chemical protection forces, the special troops tasked with protecting the military from the enemy’s use of nuclear, chemical or biological weapons and ensuring operations in a contaminated environment.
His assistant also died in the attack.
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Talks bring Russia and US ‘closer together’
Friday’s bombing came as Mr Trump’s envoy Steve Witkoff met Mr Putin in Moscow to discuss a US-brokered peace plan for Ukraine.
The talks allowed Russia and the United States to “further bring their positions closer together” on “a number of international issues”, a Kremlin aide said.
The two sides discussed “the possibility of resuming direct negotiations between representatives of the Russian Federation and Ukraine”, Yuri Ushakov said.
The talks in Moscow lasted for three hours and were “constructive and useful”, he added.
Speaking on a flight to Italy for the Pope’s funeral, the US president said he hadn’t been fully briefed on Mr Witkoff and Mr Putin’s meeting – but added it was a “pretty good meeting”.
The meeting was their fourth encounter since February.
Russia and Ukraine have not held direct talks since the early weeks of the war, which began in February 2022.
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