Sajid Javid is right that the NHS needs fundamental change – but wrong on how to go about it

We know it is possible to make the National Health Service work, because Tony Blair did it. Some of his advisers were nervous when he said in 2002 that if the NHS was not “basically fixed” by the next election, “I am quite happy to suffer the consequences”, because they worried that it would be a hostage to fortune.

But the NHS was improving fast by the 2005 election, and it was in fact “basically fixed” by the end of the Labour government in 2010. Waiting lists had fallen to such a level that people were barely aware of them. Most targets were being met, allowing the NHS to focus on more difficult challenges, such as the early diagnosis and treatment of cancers. Patient satisfaction was at a record high.

So when Sajid Javid, who was health secretary for a year until a year ago, says that the NHS is “unsustainable” and needs “fundamental change”, the correct response is to point out that this is only true because we have had a Conservative government for 13 years that has systematically “un-fixed” it.

The Tories cannot blame the pandemic because everything was going wrong before the virus arrived, although it has made it harder to put right the underspending of the previous 10 years.

From the informed position of someone who had to try to mend the NHS, Javid is right. It does need fundamental change. He doesn’t say so directly, but he compares it with health services in France and Sweden, implying that we should adopt a social insurance system of the kind that is the norm in continental Europe.

He is probably right about that, too. He was a member of a government that demonstrated that the NHS has a “fundamental” problem, which is that while it can be fixed if a government has the political will, it cannot stay fixed.

As a national service funded out of general taxation, it is always going to be vulnerable to a squeeze on public finances. David Cameron and George Osborne did not mean to run down the NHS; indeed, their rhetoric was all about how much they loved it, and how they had abandoned the Thatcherite notion encouraging people to opt out of it.

Michael Howard’s “patient passports” were filed in the dustbin of history. Cameron and Osborne even “ringfenced” NHS spending to exempt it from their attempts to cut the deficit. But that wasn’t enough: they failed to keep on increasing NHS funding in real terms so that it could keep up with the pressures of a growing and increasingly elderly population.

It might be possible to put that right if we had another 13 years of a Labour government. It might even be possible if we had 13 years of a Tory government that was as committed to higher NHS spending as Labour would be. Theresa May and Boris Johnson made fitful attempts to do that, but had not started to see results when the coronavirus struck.

But even if sustained levels of higher spending were achieved, they would be bound to slip back again when a government less fanatical about high spending was in charge.

The only way to break this cycle of adequacy followed by retrenchment would be to move to a social insurance system, in which the costs of healthcare are shared between taxpayers, patients and employers – ensuring buoyant revenues over the long term.

But how to get there? In my view, Javid’s proposed royal commission is the wrong way to do it. The right way is to elect a Labour government and let Wes Streeting do the hard work.

I can see Javid’s point: fundamental change needs cross-party support, but the way to achieve that is for one party to make a success of the change, which will force the other party to support it. It is what New Labour did on schools and gay rights, for example.

And it would have to be Labour that did it. As Streeting said last week, “Just as only Nixon could go to China, I’d wager that only Labour can reform the NHS.” Only Labour would be trusted by the British people to inaugurate a reformation in the national religion.

Streeting has done some good work in preparing for government, having learned from the experience of 1997, when Labour had done some hard thinking about the Treasury and education, but had left the NHS alone. That meant that it took most of Labour’s first term to get started, with the public spending taps not opened until halfway through.

Streeting has already started to sketch out some significant reforms, including the idea of bypassing GPs as the exclusive gatekeepers of NHS services. He understands that the New Labour programme of empowering patients needs to be supercharged, and that the tech revolution needs to be harnessed better.

If reforms of these kinds are pushed, alongside higher spending, the NHS could start on a 10-year transition to a different and better model. But only Labour, and only a moderniser such as Wes Streeting, could do it.