This is something that has been done many, many times before by lots of medical professionals, politicians, think tanks and other various people attached to the NHS in some way. We have had the insiders view, the outsiders view, the private healthcare view and on exceedingly rare occasions, patient views. How will this be any different? I guess it won’t, at least it won’t set out to be different for the sake of it.

One of the first things I’d like to set out is that I have no ideological attachment to the NHS, I’m sure this will anger many who do and delight others who don’t. The way I see healthcare is as a service function, it should be there when people need it and provide patients with a good and fast service, how it is provided doesn’t trouble me as long as the taxpayer isn’t being ripped off and patients are getting the services they need without the requirement to pay for it. Healthcare is both a strategic resource for the nation and a day to day need for patients, balancing these requirements is what I wish to address.

How do we, as a nation, pay for unlimited healthcare liability in a resource limited economy? What does the UK economy look like with an ageing population that has neither looked after it’s health or saved enough for private health or social care provision? These are two of the most pressing questions facing the new Labour government, questions that will need answering much sooner than people currently realise. The state is running out of spare capacity to borrow money, the trend growth rate no longer generates excess tax in a given year, tax rates are already at a level which inhibits growth and raising them higher will further decrease an already falling trend growth rate and cutting non-welfare (everything except healthcare, benefits and social care) spending is a non-starter even in this Tory’s opinion. State spending is so low in some areas it’s holding economic growth back, cutting it further will hurt the economy more than the saved money can help in other areas.

So what’s the answer? In all the years following politics and more specifically the NHS debate I’ve only ever seen one solution proposed by both parties, increase supply to match demand, this inevitably means more money or spreading resources more thinly over a larger surface area – usually a mixture of both. There have been faults, IMO, by both parties, Labour when they gave in to GPs in the 00s and the Tories with the ill fated Lansley reforms which exacerbated an already poor marketised structure within the NHS. There is a lot of blame to go around, Labour got less supply for more money and the Tories got the less supply by creating a new layer of bureaucracy that sucked up the already limited resource. What is important to note is that employment within the NHS is now higher than ever yet patient outcomes are worse than ever, clearly something is fundamentally broken with the path we have taken.

While increasing supply may still be part of the solution, and reforms plus cash to do so may paper over the cracks for a few years, it doesn’t solve the first problem – how we fund unlimited healthcare liability in a resource limited environment? The answer must therefore lie on the other chart axis, it is to demand reduction the new government must look. The UK has one of the most unhealthy populations across Europe, early stage intervention is unheard of and even when patients are crying out for it the NHS seems unable or unwilling to help people help themselves. Simply put the UK population has become fatter, older and more prone to cancer over the last 30 years due to poor eating habits, smoking and lack of exercise. Far too many are reaching their early 60s with diabetes, blocked arteries, cancerous organs and a BMI of 30 or over.

How do we reduce demand though, I hear everyone asking, well Wes Streeting has decided that drugs seem to be the best approach with the Jabs for Jobs drive and he’s now having to insist that this is not the start of a dystopian future where fat people will be forcibly injected with Ozempic against their will. This approach is dismal. It completely absolves people of personal responsibility for their own health. Instead it suggests that we, the public, are too stupid or too lazy to improve our health and we just need to injected with drugs. Most people want to be healthier but there are a generation of adults who never learned how. My parents generation, baby boomers, is that generation. A huge proportion have little concept of what is and isn’t good for them to eat, they underestimate the value of daily exercise and too many are addicted to social media telling them that life’s ills can be resolved by “three simple steps” that invariably don’t work.

We must tackle health issues in this generation with proactive healthcare approaches. Instead of medicating type 2 diabetes, an earlier approach to push people into mandatory diabetes treatment to reverse the pancreatic damage is a better investment for the nation with residential stays if necessary. We’ve already tackled smoking and largely the damage is already done there. Routine earlier screening for arterial narrowing must be on the agenda, we cannot wait for 60 somethings to have a stroke or heart attack as it results in a massive care bill for patients who temporarily or permanently require care after a serious stroke or cardiac event.

Finally there must be an all government approach to healthy living and dieting, this, unfortunately will initially feel like and be nannying. It may require discouraging purchasing of processed foods high in saturated fats with the tax system or using the food regulations to limit the amount of saturated fat a portion of processed or ready prepared food can contain both in supermarkets and in restaurants, it will need labelling of nutritional content in all restaurants and pushing through a reduction in average portion sizes. We must also further investigate the deleterious effects of ultra processed foods on our bodies and begin the hard task of regulating these foods and additives out of existence even if it results in a reduction of convenience for people.

Few of these are an appealing option to me as a freedom loving Tory, yet I recognise the ill effects of poor food and health education of the 60s, 70s and 80s among my parents generation. They simply didn’t have all of the facts then and cheap calorie dense meals full of space age additives after rationing must have been a revelation for them and their parents. It has left behind a legacy that we must all face up to. If we don’t then we really will become a healthcare system with a nation attached to it.

Max PB