To heal the divisions of the Brexit referendum it is vital that we recast Brexit as an inspiring moment of electrifying and comprehensive national renewal — economic, cultural, political.
This is an opportunity to re-energize our approach to domestic issues even if they have nothing to do with Europe — to excite and carry with us those who fear Brexit is a distraction from the real issues we face as an aging nation, like the modernization of the National Health Service (NHS) and our system of social and elderly care.
As the general election last year showed, no issue is more vital to voters or to our society and economy. For too long the politicization of the NHS has held back the debate we need to have about how to fund European standards of health and care in 21st century Britain. Whilst ministers negotiate Brexit over the next 15 months the prime minister also needs to set out more clearly why Brexit will be a moment of domestic renewal.
I have worked in and around the NHS most of my career and served as minister for health innovation in the coalition government under David Cameron. I sense that since the saga over the then Health Secretary Andrew Lansley’s reforms in 2012 — a radical shake-up that imposed clinical commissioning groups as local bodies within the NHS spending tens of billions in health funding directly — there is a general weariness with top down “big ideas” from ministers in Whitehall. As most frontline NHS staff will tell you, the real challenge is how to structure and fund integration with social care, improve localization and liberalization from Whitehall controls and targets, as well as giving local leadership more freedom.
Without a clearer vision for a more sustainable NHS and social care system in the 21st century, I fear we will exhaust the goodwill of the frontline NHS staff who keep the system going. The greatest asset and the most special and extraordinary thing about the NHS is their willingness to go the extra mile for it. That’s because it is a uniquely and quirkily British, national, not-for-profit service for all citizens based on need, rather than ability to pay.
In a world which seems increasingly to atomize and commodify everything and which knows the price of everything and the value of little, the ethos and values of the NHS are its most treasured asset. Despite presiding proudly over increased funding through the entire history of the NHS, the Conservative Party’s tendency since the 1980s to sound as though it doesn’t value this has allowed us to be misrepresented as callous marketeers obsessed with creating a marketized system.
That’s why I believe we need to take Brexit as a moment to re-covenant our support for the ethos of the NHS, with a new and refreshed funding “contract” fit for 21st century Britain.
The exhaustion with toxic politicization and top down “initiativeitis” means that even if it were possible for one party to do the necessary work to set out a sustainable model, I think the service would reject a one-party solution. That’s why I support Health and Social Care Secretary Jeremy Hunt’s calls to take the politics out of the NHS by transferring its management from ministers to NHS professionals accountable to ministers and parliament.
It’s also why I support the calls for a cross-party commission to look in detail at how the NHS operates and how it could be improved. I believe there are a number of people like the Lib Dems’ Norman Lamb, Labour’s Liz Kendall, a number of distinguished peers and myself who could happily and effectively work together to frame a nonpartisan model for a 21st century health and care system.
With costs rising due in part to an aging population, we must consider how the NHS is funded. We need to be less parochial and look at how other countries fund their health care systems. We should aspire to be amongst the world’s leaders in health spending as a percentage of GDP. The vast majority of European countries run on the basis of national and corporate insurance-based payments, copayment, and companies and users who can afford it being obliged to contribute to their health costs.
We have to end the idea that co-payments, top-ups, are somehow antithetical to an NHS. We already run a mixed health care economy with the NHS alongside a huge charitable and independent insurance-based sector. Nobody wants an American-style insurance-based system, but there’s a huge range of different models across Europe which we should look at in designing the right system for a modern U.K.
As I set out when I was minister for life science, we also need, on behalf of patients, to harness properly the value of the NHS as a research engine: attracting new investment, getting NHS patients faster access to innovative treatments and allowing the NHS to secure discounts from the life science industry on new drugs by helping to do the research to discover them.
This is an exciting agenda. We need to pursue Brexit as the moment we properly grip these opportunities for the next generation.
George Freeman MP is chair of the Conservative Party’s policy forum.
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