What would it really take to reform the health service?

Even after recent marginal improvements, NHS waiting lists remain high and government performance targets are being missed. Public satisfaction levels are at their lowest since Labour left office in 2010, and cancer survival rates are poor. Ambulances take about twice as long to turn up as they are supposed to.

- SEAN O'GRADY

There are around 100,000 staff vacancies within the health service, and the pay and conditions offered to its current staff are prompting skilled medics to leave. Industrial relations are notoriously poor. Yet the NHS is also the sixth-largest employer on the planet, only outnumbered by the Indian Ministry of Defence, the US Department of Defense, the People’s Liberation Army of China, Walmart, and Amazon.

The NHS spends around £230bn per annum. That sum should put into perspective the £2bn package promised by Rachel Reeves, and the £2.5bn funding boost plus £3.4bn in capital funding over five years announced by Jeremy Hunt in the last Budget. Both main parties talk about “reform”, but never about moving away from the present model...

Is the UK model of a national health service unusual?

Yes. Most advanced economies have a system more closely linked to the insurance industry, with a majority of the funding flowing through private, sometimes not-for-profit companies and institutions. And yet the French, Germans and Australians aren’t moaning about waiting lists. Maybe we have something to learn?

Are European private insurance systems superior?

In some respects, yes. Such a system takes a lot of the politics out of the system; further, the health insurance companies take on the role of ensuring quality of service, and they can exercise more choice, on behalf of the patients, about where to award contracts. Such systems may also lead to better outcomes, and nicer wards and rooms with optional hotel-style extras.