We need to talk about the NHS

None of the parties will discuss the fundamental questions of how to improve the service and whether it is sustainable

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The Independent Online

At the last election, The Independent on Sunday ran a series of in-depth analyses of the questions that none of the parties wanted to discuss. These included the deficit – about which there was a pre-election silence after the Conservatives realised that their talk of austerity was scaring the voters – and Afghanistan. They did not include the National Health Service. This time, though, the NHS might be one of those big unmentionables.

This might be surprising. The Conservatives may not want to talk about the NHS, changing the subject to the economy every time it is raised, saying that you need a strong economy to pay for it. But, surely, the Labour Party has made it clear that it regards the NHS as the most important single question of the campaign and goes on about it all the time.

What we mean, however, is not that the NHS will not be mentioned, but that none of the parties will discuss the fundamental questions of how to improve the service and whether the NHS model is sustainable. All the parties have made promises about NHS spending. The Conservatives have said they would protect its budget against inflation. Labour has promised to spend an extra £1.2bn a year, raised by the mansion tax. The Liberal Democrats want to spend even more, raised from their mansion tax and higher taxes on the pensions of the rich. And Ukip, which recently wanted to abolish the NHS altogether, now says that an extra £3bn a year on the service is a “red line” in its negotiations to take part in any coalition.

But none of them has said how they would ensure that the vast amount of money already being spent could be spent better. Or how the NHS can deal with the pace of technological change and an ageing population.

Two of our reports today set out the scale of the challenge. First, we report on the arduous task of turning round the 11 hospitals that were put into “special measures” two years ago after the Mid Staffs scandal. Changes to the management of the trusts with the highest mortality rates have probably saved hundreds of lives, but it is a difficult business, with three of the trusts yet to show any improvement. It would help the voters to know how the parties have learned the lessons of these interventions and how they hope to apply them elsewhere in the NHS.

Also today, Steve Connor, our science editor, reports on the latest breakthrough in the technology of mitochondrial transfer, which offers new possibilities in treating infertility. This kind of science is going to mean that all sorts of expensive treatments on the fringe of medical necessity will become possible.

In the face of these changes, Labour’s volubility on the NHS is frustrating. Ed Miliband has tried to scare people by saying that the Tories plan to reduce public spending as a share of national income to a level last seen in the 1930s, “when there was no NHS”. Andy Burnham, the shadow Health Secretary, has built his pitch on a related scare story – that the Tories want to “privatise” the NHS. Neither is true. Now that Nigel Farage has had another of his sudden policy reversals, no major party proposes privatisation in the sense of transferring NHS functions to the private sector.

Liz Kendall, Mr Burnham’s deputy, said recently, “What matters is what works.” This at least suggests an openness to new thinking. Mr Burnham himself, however, rebuffed her yesterday, saying: “What works, in my view, is the public NHS.” This is a depressingly narrow view.

Any serious party of government ought to be working on a positive plan for the future. The Conservatives cannot keep changing the subject, and Labour must offer something more specific than scaremongering.