Boris Johnson will have to work quickly if he wants to convince a nation that hasn’t voted for him that he can lead Britain through one of its most challenging periods in a generation.
This starts with unifying a country that is painfully divided along both party political and Brexit lines.
The institution that can create this unity is the NHS – if Boris can commit to protecting it. Its survival, at least in its current form, is far from guaranteed.
There’s ongoing speculation that it will be included in a bumper US trade deal, leading to privatisation, but support for the NHS is one of the few things that the vast majority of Tories and Labour, Remainers and Leavers, can agree on.
This makes it a political magic wand that Johnson will need to start waving soon.
He’s made it an early priority, using one of his first speeches as prime minister to announce ’20 new hospital upgrades’ and a commitment that ‘the money for the NHS really does get to the frontline’. There appears to be a big NHS rebuilding programme underway, to tie in with Johnson’s infamous Brexit bus pledge.
The NHS is one of the most emotive subjects in British politics, and understandably so. It is seen not just as an essential public service but an expression of national character.
It is a national treasure that is relied upon by both the poorest and the richest of Britain, and one of the few unifying factors in a divided nation.
Anxiety around the NHS’s future has been even more intense in recent months and years.
Almost daily I meet patients in my clinic with concerns regarding job security as a result of a no-deal Brexit. If the NHS simultaneously shifted to a fee-based model, they would be without income at a time when healthcare could become a literal lifeline.
What some of them miss, however, is that the NHS is already privatised to a significant extent, with more than 10 per cent of the care budget spent on provision through non-NHS (ie. private) organisations.
These concerns are echoed even more loudly by vulnerable people I meet when volunteering on Britain’s streets with the humanitarian charity Who is Hussain.
The NHS is also one of our largest employers, with 1.5million workers on its payroll or, to put it another way, one in every 20 people employed in the UK currently works for the service.
This creates a significant constituency who are invested in its survival, not only out of social conscience but personal financial interest. I should know: I am one of them, and have been for a decade.
All of this makes talk of NHS privatisation as part of a Boris-Trump Brexit trade deal terrifying to many Brits.
What some of them miss, however, is that the NHS is already privatised to a significant extent, with more than 10 per cent of the care budget spent on provision through non-NHS (ie. private) organisations. They are fighting over the horse, not realising that it has already bolted.
However, NHS privatisation has historically been completely different to the US insurance-based system, and the horror stories of the marginalisation of poor patients that is sometimes reported. It is this difference that Boris must protect.
There is broad cross-party support – with the exception of a fringe of the Conservative party – for the NHS to remain free at the point of use, and as taxpayers we seem happy to continue to foot the bill.
It seems then as if the NHS is headed not for privatisation but ‘virtualisation’. It will remain free and egalitarian in how it is received, but become increasingly privatised and multi-sourced in how it is delivered. What this means is that service levels will be maintained in the short term, but there is a risk that private suppliers will use their leverage to increase costs in the long term – it is this scenario that we must be protected against now.
Some have an ideological opposition to anyone in Britain running public health services for profit, but studies show they are in the minority.
What we need as a country are guarantees that the NHS will not go the way of other industries, where private providers get a foot in the door by delivering genuine gains in efficiency, only to later increase their prices once the system is dependent on them.
Our national health cannot be held hostage by private companies. But it must also not be jeopardised by bureaucracy.
If Boris can strike the right balance, he will be remembered as the prime minister who modernised the NHS while at the same time protecting it. That is one of the few things that can secure his legacy among all Brits – whoever they vote for or, indeed, whether they vote at all.
That is to say nothing of the people like me for whom the NHS is not just a national institution, but our life’s work.
Dr Mohammedabbas Khaki is a senior associate at the General Medical Council and a trustee of Who is Hussain, a UK-based charity active in 92 cities across five continents.
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