Tory candidates need to offer a prescription for NHS ills

The UK’s NHS is in critical condition. A record 6.5mn patients are waiting for planned treatment in England, exacerbated by backlogs caused by the pandemic. More than 24,000 people waited more than 12 hours in emergency departments in English hospitals earlier this year. A parliamentary committee this week concluded that chronic NHS understaffing poses a “serious risk to staff and patient safety”. Not that you would know it from listening to the two remaining candidates to be Britain’s next prime minister. There has been oddly little detailed policy, or even debate, over the future of the NHS proffered by Rishi Sunak or Liz Truss, one of whom will be the Conservative party’s leader — and prime minister — in six weeks.

That the leadership debate has focused relentlessly on fiscal policy is understandable, given soaring inflation and voters’ concerns over a cost of living crisis that is forecast to worsen over the autumn. Tactically, in a race decided by Tory party members attuned to candidates’ adherence to Thatcherism, it has made sense for Truss to focus on tax-cutting as a way to differentiate herself from Sunak, the chancellor during the pandemic when he — necessarily — raised taxes to their highest level in the UK since the second world war.

But the pair need to set out their stall on other topics of concern, not just to party members but also to voters and businesses. The NHS, Europe’s biggest employer, ought to be a priority. This is not least because the UK is unique among OECD countries in failing to experience a rebound in people rejoining the labour force after the pandemic, driven by chronic illness in working-age people. That means that tackling the provision of care may also nurture the UK’s long-term economic health.

Sunak has vaguely pointed to his pandemic record to argue that the NHS would be in safe hands under him. He decided last year on a manifesto-busting increase of 1.25 percentage points to National Insurance contributions for workers and employers, raising £12bn a year to fund social care and help clear the NHS backlog. The broken and long-ignored social care system desperately needs funding, as both candidates seem to recognise. But Truss has pledged to reverse the tax increase intended to fund it. Sunak’s National Insurance rise is far from the ideal way to raise the cash, but scrapping this tax change without a credible alternative seems foolhardy given the admitted need for the extra spending — and the fact that further increases may be necessary as the service continues to struggle.

Improving preventive and social care will be key for an ageing population with chronic conditions and will help ease the burden on the health budget by preventing rather than just treating problems. UK spending on healthcare is around 12 per cent of GDP (up from 9 per cent before the pandemic), slightly higher than other comparable developed economies. But it also allocates more of overall expenditure to hospital care than some of its peers, leading successive governments to try to eke out productivity gains in hospitals. With average bed-stays now at almost the shortest among OECD countries, at 4.5 days, there is only so much slack left in hospitals to cut.

There are no quick fixes. The health system, with necessarily long lead-times on training medical staff and building facilities, needs to be run on longer-term budget cycles. An NHS that is not fit for purpose is one rapid way for any government to lose disenchanted voters. The next prime minister needs to accept the prognosis and devise a treatment plan as a matter of urgency.

This is the first in a series of editorials examining the Conservative leadership candidates’ stance on key policy issues