Time to think the unthinkable and break up the NHS says Dr Saqib Qureshi

The choice is not binary, between an undeniably bureaucratic behemoth on the one hand, and an unbridled free market on the other. We can and should have the best of both worlds.

Opponents will repeat their mantras that any significant reform will be ‘stealth privatisation’ and that ‘the NHS is the best of Britain’.

They will find a receptive audience: Almost no-one wants to turn the clock back to pre-NHS times, when healthcare was an ineffective hotch-potch of private and municipal services, supported by fledgling charity schemes.

When the NHS was established in 1948, it symbolised the Keynesian, post-war preference for close market regulation and state-subsidized public service delivery. The public, still invigorated by the national-effort blitz mentality, welcomed the world’s first free national health service with open arms.

And in the early days of the pandemic, it was impossible not to notice the NHS rainbows, implying that not only were its staff indispensable to society, but so was the institution that employed them. Commitment to the NHS is perhaps the closest thing we have to a British constitution.

But things are changing as the pandemic drags on. This time, we are not clapping - we are sighing. And we are questioning.

The NHS’s size is increasingly looking like a disadvantage. Big ships turn slowly, and in a storm you need to be agile.

The number of Intensive Care Unit (ICU) beds is low by international standards. The amount of staff in the NHS is also lower than our European counterparts: at 2.8 doctors per 1,000 people compared with the EU’s average of 3.9.

And crucially, the vaccination process is slower than expected, despite the Oxford/AstraZeneca vaccine being produced domestically, and not requiring cold storage.

Israel is leading the way when it comes to vaccine rollout. There are many political and cultural factors for this, but one of them is that they essentially have more than one NHS. It is harder to say that something is impossible when one of your competitors is doing it, and you are losing clients as a result.

Even beyond vaccines, Israel’s health outcomes are much better than the UK’s, with the lowest infant mortality rate, and some of the highest median life expectancy rates in the world. And Israel’s healthcare service is still publicly funded - it has managed to achieve private sector quality with public sector guarantees.

Israel has four separate health funds that receive state funding partly based on how popular they are - providers have an incentive to appeal to more users, who are given choice.

By law, these healthcare providers cannot turn away any Israeli citizen, and they must provide a minimum level of care that is set by the government - there is still oversight and quality assurance.

For the sake of our health, we must reconsider our often unchallenged assumption that a state-funded public service must operate as a monopoly, and that competition is exclusive to the private sector.

I suspect that many decision makers know this: The NHS already has a limited level of this competition, which has been proven to improve health outcomes. Since 2006 patients have been able to choose between providers for various types of care, while payment is made by the NHS.

Research has shown that this has led to reductions in heart attack mortality rates, and faster service for routine procedures like hip replacements, cataract and hernia operations.

When something works, we should do more of it, and to hell with the bureaucrats and the red tape. No institution is beyond reform - even the NHS.

For all its flaws, the NHS remains one of the greatest British institutions. Lets allow competition, so we can keep it that way.