The mounting challenges facing Britain's NHS

When asked about the National Health Service, the seven politicians assembled for a televised political debate answered in time-honoured fashion. David Cameron paid tribute to the extraordinary work undertaken by the NHS, before boasting of thousands of "bureaucrats" he had laid off. Boldly he promised to rid the service of thousands more. The rest lambasted the prime minister for embarking on expensive and unnecessary reforms, and swapped dark accusations about the "creeping privatisation" threatening Britain's favourite institution. All promised ever more doctors and nurses as the cure for the NHS's ills.

Beneath the bluster, the UK debate about what good healthcare policy looks like is characterised by a deadening consensus. More spending, obviously, is good, and the coalition's trump card is the ring-fence it erected around the NHS budget at a time when other departments faced double-digit cuts. Also on the side of righteousness are general practitioners, hospital doctors and nurses. Against them stand a familiar cast of villains: bureaucrats tying up hospitals in red tape, meddling politicians attempting top-down reform, and a private sector rapaciously profiting from the public purse.

Despite high public satisfaction with the NHS there are good reasons to fear for the years ahead. All through winter, waiting times in accident and emergency wards lengthened, as did the list of cancelled operations. With the NHS caught between an ageing population and tightly constrained budget, this deterioration is not expected to reverse itself. There are currently 3 million people aged 80 or over, a number projected to reach almost 6m by 2030. They cost the NHS seven times more than those aged just 30.

Simon Stevens, the savvy CEO of NHS England, has set out a scenario for the NHS in 2020 that manages with a mere £8bn increase to its budget - so long as it implements 2-3 per cent annual efficiency gains. But a study for the Financial Times has found productivity growing at less than half this rate, threatening a far larger funding gap. Unless this is addressed, either services will need to be curtailed or taxes will have to rise sharply merely to maintain standards at their current level.

The good news is that outstanding hospitals demonstrate the sort of stunning productivity increases that could be within reach of all. The cost of operations still varies wildly; bringing the worst performing up to scratch could save £100m. Individual hospitals show the way. Through the more rigorous use of data and performance-based pay, Salford Royal NHS Trust in Greater Manchester has driven up standards, improved safety and cut costs. Advances in productivity are not only found at the bleeding edge. Many hospitals could realise significant gains merely by updating how they handle their staffing rosters.

Whatever the challenges that are likely to confront the NHS, they bear little relation to the bugbears politicians habitually raise at election time. Just 6 per cent of work is handled by the private sector, and less than 3 per cent of NHS staff work in management. Neither of these numbers is excessive. Simply calling for more doctors or nurses does nothing to enhance productivity. More likely, the improvements will come from inspired local leadership, which the government should be doing what it can to encourage. After all, the person driving the improvements at Salford Royal, Sir David Dalton, is himself one of those bureaucrats. So too was the audience member who anxiously questioned the prime minister about safeguarding the future of the NHS.

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