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
Please use Chrome browser for a more accessible video player
‘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.
Read more:
‘Climbing over people… blood in the floor’
Nurse suffers miscarriage after five-hour A&E wait
Please use Chrome browser for a more accessible video player
‘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”.
Read more:
A&E waits hit new high
Worst region in England for handover times
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.
Read more:
Are NHS failings to blame for extra deaths?
What happens to the body while waiting for an ambulance?
Please use Chrome browser for a more accessible video player
‘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.
Read more:
NHS ‘clearly not working’
Pharmacy boss warns of shortages
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.
Read more:
‘I’ve never seen anything like this’
NHS workers describe daily ‘firefight’
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.
Read more:
How many spare beds does your local hospital have?
New COVID variant is fastest-growing strain in the UK
Please use Chrome browser for a more accessible video player
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.
Donald Trump has said American troops will not be sent to Ukraine, but the US may provide air support as part of a peace deal with Russia.
A day after his extraordinary White House meeting with Ukrainian President Volodymyr Zelenskyy and the leaders of Kyiv’s European allies, the US president told Fox News “when it comes to security, [Europeans] are willing to put people on the ground. We’re willing to help them with things, especially, probably, by air”.
Ukraine war – follow the latest developments
Mr Trump did not elaborate, but White House press secretary Karoline Leavitt told reporters US air support was “an option and a possibility”.
She said the US president “has definitively stated US boots will not be on the ground in Ukraine, but we can certainly help in the coordination and perhaps provide other means of security guarantees to our European allies”.
Air support could take many forms, including missile defence systems or fighter jets enforcing a no-fly zone – and it’s not clear what role the US would play under any proposed peace deal.
Please use Chrome browser for a more accessible video player
What security guarantees could work?
Zelenskyy-Putin summit
It comes as planning for a possible Zelenskyy-Putin summit get under way. Talks between the Ukrainian and Russian president are seen by Mr Trump as vital to ending the war.
Sky News understands a meeting could happen before the end of the month, with Geneva, Vienna, Rome, Budapest, and Doha among the venues being considered.
Geneva, Switzerland, is considered the best option, with Rome or the Vatican disliked by the Russians and Budapest, Hungary, not favoured by the Ukrainians.
European allies are understood to want security guarantees to be defined before the meeting.
A NATO-like treaty, guaranteeing Ukraine’s allies would come to its defence in case of any future Russian attack, is being worked on and could be completed by next week.
Like the US, Sky News understands Italy is opposed to putting boots on the ground in Ukraine.
But EU diplomats are confident this is the best chance yet to stop the war, and allies could return to Washington in early September to celebrate any deal being struck.
Read more on Sky News:
‘Don’t trust Russia,’ diplomat warns
Why peace may be further away, not closer
Five key takeaways from White House talks
Please use Chrome browser for a more accessible video player
Sky’s Mark Stone takes you inside Zelenskyy-Trump 2.0
Trump still has doubts about Putin
Despite the renewed optimism about a peace deal following Monday’s White House summit, Mr Trump has admitted Vladimir Putin might not be sincere about wanting to end the war.
“We’re going to find out about President Putin in the next couple of weeks,” he told Fox News.
He’s previously threatened to put more sanctions on Russia if a peace deal isn’t reached, though previously set deadlines have been and gone.
👉 Listen to Sky News  Daily  on your podcast app 👈        
Russia launched its biggest air assault on Ukraine in more than a month on Monday night, sending 270 drones and 10 missiles, the Ukrainian air force said.
Ukraine’s European allies in the so-called Coalition of the Willing, an initiative spearheaded by Sir Keir Starmer and Emmanuel Macron, discussed additional sanctions to place on Russia on Tuesday.
World
Ukrainian diplomat involved in 90s nuclear deal with Russia warns Trump about ‘very big mistake’ with Putin
Ukrainians have given a lukewarm reaction to this week’s White House summit.
There is bafflement and unease here after US President Donald Trump switched sides to support his Russian counterpart, Vladimir Putin, dropping calls for a ceasefire and proposing that Ukraine surrender territory.
While allies are talking up the prospects of progress, people here remain unconvinced.
Ukraine war latest – Trump rules out using US troops
Boris Yeltsin (2L) and Bill Clinton (C) sign the 1994 Budapest Memorandum
Please use Chrome browser for a more accessible video player
What security guarantees could work?
The Trump administration’s contradictory statements on possible security guarantees are causing concern here.
MP Lesia Vasylenko told Sky News it is not at all clear what the allies have in mind.
“Who is going to be there backing Ukraine in case Russia decides to revisit their imperialistic plans and strategies and in case they want to restart this war of aggression?”
For many Ukrainians, there is a troubling sense of deja vu.
Please use Chrome browser for a more accessible video player
Ukrainian drone strikes Russian fuel train
In the 1994 Budapest Memorandum, Ukraine agreed to give up not land but its nuclear arsenal, inherited from the Soviet Union, in return for security assurances from Russia and other powers.
They know how that ended up to their enormous cost. Putin reneged on Russia’s side of the bargain, with his invasion of Crimea in 2014 and once again with his full-scale attack three and a half years ago.
We met veteran Ukrainian diplomat Yuri Kostenko, who helped lead those negotiations in the 90s.
Veteran Ukrainian diplomat Yuri Kostenko helped lead the Budapest Memorandum negotiations
He said there is a danger the world makes the same mistake and trusts Vladimir Putin when he says he wants to stop the killing, something Mr Trump said he now believes.
👉 Listen to Sky News Daily on your podcast app 👈        
“It’s not true, it’s not true, Russia never, never, it’s my practices in more than 30 years, Russia never stop their aggression plans to occupy all Ukraine and I think that Mr Trump, if he really believes Mr Putin, it will be a very big mistake, Mr Trump, a very big mistake.”
Before the Alaska summit, allies agreed the best path to peace was forcing Mr Putin to stop his invasion, hitting him where it hurts with severe sanctions on his oil trade.
But Mr Trump has given up calls for a ceasefire and withdrawn threats to impose those tougher sanctions.
Instead, he has led allies down a different and more uncertain path.
Read more on Sky News:
Putin wasn’t there, but influenced summit
Peace further away, not closer
Five takeaways from White House talks
Ukrainians we met on the streets of Kyiv said they would love to believe in progress more than anything, but are not encouraged by what they are hearing.
While the diplomacy moves on in an unclear direction, events on the ground and in the skies above Ukraine are depressingly predictable.
Russia is continuing hundreds of drone attacks every night, and its forces are advancing on the front.
If Vladimir Putin really wants this war to end, he’s showing no sign of it, while Ukrainians fear Donald Trump is taking allies down a blind alley of fruitless diplomacy.
World
Putin wasn’t at the White House, but his influence was – the moments which reveal his hold over Trump
Vladimir Putin wasn’t at the White House but his influence clearly was. At times, it dominated the room.
There were three key moments that revealed the Russian president‘s current hold over Donald Trump.
The first was in the Oval Office. Sitting alongside Volodymyr Zelenskyy, the US president told reporters: “I don’t think you need a ceasefire.”
Ukraine talks latest: Zelenskyy ‘ready to meet’ Putin after Trump summit
Vladimir Putin shaking hands with Donald Trump when they met last week. Pic: Reuters
It was a stunning illustration of Mr Trump’s about-face in his approach to peace. For the past six months, a ceasefire has been his priority, but after meeting Mr Putin in Alaska, suddenly it’s not.
Confirmation that he now views the war through Moscow’s eyes.
Please use Chrome browser for a more accessible video player
Trump applauds Putin and shares ride in ‘The Beast’ last week
The second was the format itself, with Mr Trump reverting to his favoured ask-what-you-like open-ended Q&A.
In Alaska, Mr Putin wasn’t made to take any questions – most likely, because he didn’t want to. But here, Mr Zelenskyy didn’t have a choice. He was subjected to a barrage of them to see if he’d learnt his lesson from last time.
It was a further demonstration of the special status Mr Trump seems to afford to Mr Putin.
👉 Follow Trump100 on your podcast app 👈
The third was their phone call. Initially, President Trump said he’d speak to the Kremlin leader after his meeting with European leaders. But it turned out to be during it.
A face-to-face meeting with seven leaders was interrupted for a phone call with one – as if Mr Trump had to check first with Mr Putin, before continuing his discussions.
We still don’t know the full details of the peace proposal that’s being drawn up, but all this strongly suggests that it’s one sketched out by Russia. The White House is providing the paper, but the Kremlin is holding the pen.
Read more:
Four key takeaways from the White House Ukraine summit
Trump has taken peace talks a distance not seen since the war began
Please use Chrome browser for a more accessible video player
Trump, Zelenskyy and the suit: What happened?
For Moscow, the aim now is to keep Mr Trump on their path to peace, which is settlement first, ceasefire later.
It believes that’s the best way of securing its goals, because it has more leverage so long as the fighting continues.
👉 Listen to Sky News Daily on your podcast app 👈      
But Mr Putin will be wary that Mr Trump is pliable and can easily change his mind, depending on the last person he spoke to.
So to ensure that his sympathies aren’t swayed, and its red lines remain intact, Russia will be straining to keep its voice heard.
On Monday, for example, the Russian foreign ministry was quick to condemn recent comments from the UK government that it would be ready to send troops to help enforce any ceasefire.
It described the idea as “provocative” and “predatory”.
Moscow is trying to drown out European concerns by portraying itself as the party that wants peace the most, and Kyiv (and Europe) as the obstacle.
But while Mr Zelenskyy has agreed to a trilateral meeting, the Kremlin has not. After the phone call between Mr Putin and Mr Trump, it said the leaders discussed “raising the level of representatives” in the talks between Russia and Ukraine. No confirmation to what level.
-
Sports3 years ago‘Storybook stuff’: Inside the night Bryce Harper sent the Phillies to the World Series
-
Sports1 year agoStory injured on diving stop, exits Red Sox game
-
Sports2 years agoGame 1 of WS least-watched in recorded history
-
Sports2 years agoMLB Rank 2023: Ranking baseball’s top 100 players
-
Sports4 years ago
Team Europe easily wins 4th straight Laver Cup
-
Sports2 years agoButton battles heat exhaustion in NASCAR debut
-
Environment2 years agoJapan and South Korea have a lot at stake in a free and open South China Sea
-
Environment2 years agoGame-changing Lectric XPedition launched as affordable electric cargo bike