A new report has laid bare the horror inside the NHS - I'm afraid there's only one option left - Miriam Cates

In the last 40 years, the number of people aged 65 and over has increased by more than 3.5 million, and those over 80 make up the fastest-growing section of our population. Very obviously this demographic change is leading to significantly higher demands for health care. In the first quarter of 2008, doctors made four million outpatients referrals. In the same quarter of 2024, there were six million such referrals, an increase of 50 per cent in just 16 years.An ageing population certainly presents a serious challenge.

But all European nations are experiencing similar demographic shifts and yet the healthcare systems of countries such as France and Germany are not, unlike ‘our NHS’, on the verge of collapse.Why is this? The obvious reason why patients wait in ambulances or on trolleys in corridors is that there are no vacant beds to which they can be admitted. This problem is caused by ‘bed blockers’, patients who are medically fit to go home but for whom no suitable social care support can be found at home.

This theory is certainly backed up by the data; last week an average of 12,591 hospital beds in England were filled with patients who were ready for discharge but unable to leave. But the reason that ‘bed blocking’ is so acute in Britain is that the UK has so few hospital beds overall.

As of March 2024, there were 160,642 hospital beds in the United Kingdom, which works out as 2.4 beds per UK citizen. France, in comparison, has nearly six hospital beds per capita and Germany has eight. If NHS bed capacity was trebled to bring it in line with German levels, no British patient would ever need to be treated on a corridor.

It's not just our bed capacity that falls well behind continental norms. For every one million people, Italy has 30 MRI scanners, Greece has 31 and Finland 29.

Yet the UK has just seven MRI scanners per million people. Unsurprisingly, not only are treatment waiting times much longer in the UK than in comparable countries but our outcomes are worse too—Britain has higher avoidable mortality rates than many of our neighbours. Our doctors and nurses are highly skilled and work hard, but we can no longer pretend that the NHS is the Rolls Royce of international healthcare systems. In truth, it bears more resemblance to a knackered old bike. So how has the United Kingdom, a wealthy, sophisticated and scientifically advanced nation ended up with hospitals that resemble warzones? To answer that, we must look at both the size and the source of NHS funding. The NHS costs an enormous amount of money - £192bn a year and rising.

Despite this, British healthcare is still underfunded compared to similar nations. The UK healthcare spends around £4,426 on healthcare per person each year, significantly less than Germany, Austria and Switzerland, where the budget is more like £6,544 a head.

We cannot expect the same standard of medical care as other European nations if we spend so much less. Yet it is all but impossible to raise British healthcare spending any further because, in the UK, there is just one source of funding for the NHS - that’s you and me, the taxpayer. When healthcare has to compete with other important public sector services such as education, defence and policing for funding from the same pot of money, there are practical and political limits to how much more can be diverted to health. Raising the NHS budget to German levels would require an additional £150billion of taxpayer cash each year- that’s more than the entire cost of the state pension. Most other countries have a hybrid model, where the government provides some of the funding, but this is topped up by private insurance. Whenever anyone mentions the ‘p’ word, those on the Left start hyperventilating and telling apocalyptic stories about the privatised US health system.

The American healthcare system is indeed uniquely awful. Americans spend more on health than any other country in the world, and yet their outcomes are the worst of all the developed nations. But the US is the exception; there are many other possible models such as those operated by France, Germany and Israel that all combine state funding, support for those on low incomes, and private insurance.

A hybrid model would enable the UK to increase the amount of funding to healthcare, which is an essential prerequisite to raising standards to those of our neighbours. A part insurance model would have two other important benefits.

Firstly, introducing an element of individual health insurance would be much fairer. When the NHS offered only emergency care and a limited number of treatments for routine illnesses, a socialised, publicly funded model was a fair one. Those who are unlucky enough to get sick are treated for free, and we all share the cost through taxation. But now that 40 per cent of the NHS budget is spent on what is euphemistically called ‘lifestyle diseases’, this model seems increasingly unfair. As someone who drinks moderately, is a healthy weight and has never smoked, I increasingly resent my hard-earned cash being spent on treating people with entirely avoidable health problems.

The way the NHS is funded actively discourages personal responsibility: other people pay for the consequences of your bad decisions. Emergency care and treatment for children and the destitute should always be free and publicly funded.

But introducing a partial insurance model where premiums depend at least in part on your personal risk factors would inject some much-needed fairness into the system. It might also lead to healthier lifestyles.

A hybrid-funded healthcare model would also mean that the money is much better spent. Of course, a poorly regulated highly commercialised American-style system results in far too many health dollars being syphoned off as private profits. But a fully nationalised system also fails to see money well spent, as our NHS is living proof.

When no one has any incentive to save money, when there is always a magic money tree in the form of the taxpayer begging for more funds, efficiency is a fantasy. And equipment suppliers and pharmaceutical companies rub their hands in glee - without the accountability of customers demanding affordable prices and shareholders requiring dividends, the NHS does not have the levers or the incentives to achieve good value for money. Waste is inevitable. The NHS served us well for over 50 years.

We should be proud of its many successes and the millions of doctors, nurses and other healthcare workers whose skill and commitment have saved countless lives. But times have changed; with an ageing population, far more treatments available and epidemic levels of obesity, a new model is needed.

As Albert Einstein said, the definition of stupidity is doing the same thing over and over again and expecting different results. Throwing more money at the NHS - even if we could afford it - would not solve the problem. Reform - and responsibility - is what must be prescribed.