Once again the question of NHS funding has been raised. The ring fence is shown to be diluted by the fact that the increasing numbers being treated offsets the maintenance of expenditure limits, so that the NHS is actually suffering from a year by year decrease, or will do unless something is done. This brings into focus all the arguments about expenditure /care ratios.
It will never be resolved, no matter how many re-organisations occur, nor even if funding is increased, until the penny drops that there is a structural flaw in the design of the basic NHS concept. You cannot provide a variable and expanding service on a fixed budget. The easiest way to illustrate this is an Orwellian world in which the major supermarkets were given franchises to feed the nation free at the point of consumption, but on a fixed government funded budget. Soon there would be waiting lists for Marmite.
The simple reform for the NHS is this. Instead of paying it to do the job, allow it to charge for having done it. In other words just like any other trade, business, or profession the operational NHS would charge the government for each individual function it performed of a medical character, drug it supplied and treatment it administered, for which, just like private medicine and insured medical systems overseas, it would bill, not an insurer,but the government.
The more it did, the bigger the bill. Everything would be published. The true cost would then be clear and taxpayers would have the choice of paying whatever taxes were needed to keep it going or electing a government which introduced charges for the better off to reduce the taxpayer burden but not the overall cost, based as it would be, on need. Clearly there would be a price list for everything and this would allow sufficient margin for coherent and efficient administration, research and infrastructure.
It would immediately become apparent that a quango free structure would be best, under the responsibility of a Ministry of Health with the elimination of health trusts, commissioning boards and other fancy nostrums. It would also become necessary for all doctors who were trained at public expense, which at the moment is all of them, to be direct employees of the NHS, like nurses. Additionally their eighteenth century hierarchy would have to be dismantled and replaced with a modern merit driven career path.
Do not expect this to happen but be clear that until it does there can and will be no solution to the endless problems of a health service which works after a fashion but can never work well.