If the UK can solve the NHS at 75, then we can solve anything!

Blain’s Morning Porridge – July 4^th 2023: If the UK can solve the NHS at 75, then we can solve anything!

“The NHS will last as long as there are folk left with faith to fight for it.”

Strip away all the political nonsense, the decaying infrastructure, even Brexit, and the real issue to solve at the core of the UK’s multiple problems is the National Health Service. Solve that, reboot it and relaunch it, and everything else may fit back into place. Its worth a try.

 Sorry for very, very late Porridge this morning… lots of stuff on at moment..

Our cousins in America are on holiday today – celebrating by drinking love-on-a-boat beer and competitive hot-dog consumption… which means we can be rude about their impossibly polarised politics and politized Supreme Court behind their backs… But, let he without sin cast the first stone… Politics in the UK isn’t much better.

The UK will have a general election sometime in the next 18 months. The vote on the future of Britain will boil down to the current unpopularity of the Conservative Party after the most chaotic period of political instability and economic decline in recorded British history, versus hopes a new (post-Jeremy-Corbyn-lunacy) Labour Party will deliver an economic renaissance, recovery, purpose and certainty.

As I’ve said before; Hope is never a strategy. My hope is Labour will succeed. My fear is Labour will prove only marginally less incompetent than the current incumbents.

The challenges facing whatever UK government we get will be huge – and will require decades to implement, not the 5-years of short-term sticking plaster solutions we typically get following one election ahead of the next one. I suspect Labour’s plans will find themselves stymied with the nation’s finances in dire-straights, infrastructure crises reaching crescendo pitch, the UK’s decreasing attractiveness to foreign direct investment potentially triggering a sterling crisis, Brexit frictions, and the likelihood left-wing agitation could unfocus Sir Kier Starmer’s programme (whatever it is..), as effectively as the right-wing is undoing Rishi Sunak.

I have my doubts any new government will have the bandwith, bravery, resilience or dedication to really solve the nation’s biggest problems.

Fortunately, there may be hope. If we can get one thing right, it will give us the confidence to solve everything else, and give us something to be proud of…

This week the UK’s “celebrates” the 75^th anniversary of the National Health Service – something we are enormously proud of because it is good, fair and equal, but which has become a bloated cash-guzzling, career devouring, sacred-cow that could ultimately bankrupt the nation. To criticise the NHS is beyond treachery… we must sacrifice more and more to it. The costs of healthcare in the UK have risen from 27% of public spending in 2000 to 44% today, yet the service is creaking and close to collapse. (And I’m not even sure that number includes the costs of pensions for Europe’s largest employer!)

This week the Prime Minister made mutterings about lots more doctors and nurses to be trained to serve its unquenchable appetite. No politician will risk to criticise the NHS, fearful voters may think less of any narrative less than “unquestioning adulation” according to a politician chum. He says every single senior political head knows the model is broken, but none is brave enough to say-so.

As a man with a dodgy ticker I have more reason than most to support the NHS – and I do. But it must be reformed, re-imagined and re-launched.

This morning the front page of the Thunderer (The Times of London) was given over to this article: Sajid Javid: Ailing NHS has made us sicker Javid is a good man.

I have little time for politicians – even less for Tories since 2010 – but Javid finally said what needs to be said. He has identified a pathway to begin the reconstitution of the NHS.

The former Tory Chancellor (albeit short-lived) and then Health Minster before he resigned in disgust over Boris Johnson, Javid is proposing a fundamental reboot of the National Heath Service – something much more than just more money – but addressing the crisis from every angle. And he is making these proposals as he prepares to leave Politics at the next election.

Javid is calling for a Royal Commission to identify how to reboot the NHS. Today it is unsustainable, can’t cope with demand, consumes record funding, and is broken. “The entire British State is on the verge of becoming a subsidiary of the NHS” he says. He charges “politicisation” and short-termism by both Conservative and Labour have dumbed down debate on solving the crisis.

The core issue is the NHS is 75 years old – and show its age and dementia. It’s “frozen in time”: launched in the 1940s when the age-related and obesity problems of today were unforeseen. The demand for NHS services has changed, but the system and service has not evolved with demand. By putting decisions into the hands of a Royal Commission the political deadlock could be broken and a new NHS put in motion.

A new NHS could become vastly more efficient. They say there are too many managers – but there are not enough good ones to oversee as shift to utilise AI, data on patients, and regular testing to improve diagnoses and treatment. It could focus on the key issues of ageing populations, preventative medicine rather than reactive, and the diseases of obesity and mental health. It could refocus medical provision on care in the community, on GPs, smaller specialist units and more care-homes for the population mix today. And yes, me may have to ration services by charging for A&E, and GP visits – with free access to the ill, disabled and elderly.

Putting in place a health service that reacts to the changing needs of society rather than struggling to match its resources to an evolving society lies at the core of the problem. Javid is quoted in the article: “Of course, as we approach that next general election, political parties will energetically debate the future of the NHS. But behind closed doors, they know the current set-up is unsustainable. Saying that publicly is much more difficult.”

Interestingly for a politician, Javid has praised Labour’s shadow health secretary Wes Streeting, the man likely to be in charge sometime soon, for Labour’s policy re the defacto nationalisation of GPs back into the NHS.

This feels like a real opportunity for the UK to solve perhaps its biggest issue – fixing the NHS as a sign the UK can also be repaired. I would suggest Rishi Sunak, Sir Kier Starmer, Wes Streeting, and current health secretary Steve Barclay (nope, never heard of him), get together, and get the Royal Commission underway at the earliest opportunity.. And maybe appoint Javid to run it before some hedge fund poaches him.

The upside of sorting the NHS to the UK would be significant – removing doubts on the government’s ability to sort out the current services/debt mismatch, and demonstrating political cooperation to a global investor base increasingly uncertain where the UK is headed.

After the NHS we just have to solve for Brexit, Water, Power and Energy, Education, Defence and just about everything else.. and UK will be tickety-boo again. All we need to do is talk.

Out of time, and still trying to do a day job..

Bill Blain

Strategist – Shard Capital