Our NHS is very sick: here are two ways to help it recover

But now, as a 75-year-old pensioner, all is not well. Access to the service is far from straightforward, and is painfully slow (literally, in many cases). Although the quality of treatment remains very high, the length of time taken to access it means that the outcomes are often poor. And, inevitably, the cat is out of the bag on the NHS being "free" at the point of need. There’s no such thing as a free lunch, and there’s no such thing as a free health service; several thousand pounds of the average earner’s annual income tax bill goes directly to the NHS.

We are losing our religion. This week’s report, compiled by the British Social Attitudes Survey in collaboration with the Nuffield Trust and the King’s Fund, reveals that the national love affair with the NHS is on the rocks.

Fewer than one in four people report satisfaction with the NHS. Almost three in four cite waiting times as the main reason for their dissatisfaction. And so they should. The NHS, in all of its mildly different forms across the UK, is not a good health service relative to our rich peer countries.

Confirmatory data on this is not difficult to find, and not difficult to interpret. In this country, compared to other OECD countries, we spend a significantly above average amount of money on our health service, and yet we get a lower than average outcome in key areas such as cancer mortality and survival from heart attack and stroke.

Why? The answer is actually quite simple: capacity.

Despite the high level of funding, we have only 2.4 beds per 1,000 people, only a little over half of the OECD average and around one-third of the number in Austria, a country I choose because they spend an identical proportion of their GDP on health.

Similar data is depressingly evident when it comes to our kit - we have a relatively very low number of MRI and CT scanners.

We have roughly three doctors per 1,000 people, again less than the average, and a whole doctor per 1,000 people fewer than Switzerland, which again I choose because they invest the same in their health service as we do in ours. We are not trying to put it right either; we are training fewer doctors than the OECD average and, astonishingly, we train only half the number of doctors per head than our friends across the Irish Sea.

In other words, we are spending enough money on the NHS, but we are spending it in the wrong places and therefore we have insufficient capacity, and long waiting times. So, what should we do differently?

Yesterday, on these pages, Rebecca McQuillan wrote a thought-provoking article on how to return the NHS to a loftier position, as a service which might be envied in other countries around the world. Reading much of it, I found myself nodding in agreement.

In particular, the focus on prevention is absolutely critical both for population health and to protect the budget for the NHS. The success of a holistic health service should not be in how many people it treats, but in how many people it does not need to treat!

This is of particular importance in Scotland, an unhealthy country with a perpetually poor cross-generational problem with healthy living.

Read more: NHS is falling apart - we need brave politicians to solve this crisis

Read more by Andy Maciver: Three steps Scotland can take to reach net zero

Read more by Andy Maciver: We should dream of the devolution we never really had

This cannot be solved overnight, and other problematic policy areas act as co-dependents. We need more and better employment, with better pay, and that needs economic growth. We need a generation of children who understand the importance of nutrition, physical activity and mental resilience, and that needs to be baked into the education system. We need more and better housing, which requires an entirely different policy environment to the one currently being pursued.

However, while this is all agreeable, there are two additional, unavoidable and necessary changes without which the NHS will not live to being a centenarian.

The first is the structure of the service. Unlike our peers across Europe, the NHS is a centralised service with only one provider - the government. In other countries, hospitals and healthcare centres are run by a variety of bodies, including central government, local government, charities and companies. All are part of a nationwide system, but the existence of multiple providers means that there is significantly more capacity - beds, machines, doctors and nurses.

A focus on prevention would help ease the burden on the health service (Image: PA)

Patients are able to make choices about where they access their treatment, based on waiting lists, expertise and any other metric on which they wish to base their assessment, and providers must be competitive and responsive to patient needs. And in this decentralised system, money, instead of being used primarily to prop up the system, is used to build hospitals, buy beds and train doctors.

Secondly, we need to change the funding of the service. We should view this much like we view pensions. There is a state pension which exists to ensure a basic level of income for people in old age, but we can choose to save additional personal pension and, now, there is a legal requirement for employers to provide an occupational pension.

The same structure can be applied to healthcare. Tax funding can provide a basic service to all, supplemented by personal and occupational payments. The more people can pay into, in effect, social insurance provision, the more taxpayer money is left in the pot for those who cannot afford such additional payments to access faster treatment.

Far from being an elitist or two-tier system, this would be an egalitarian outcome whereby those who can afford to pay more, pay more, and those who cannot, do not.

In the NHS of the past, the national religion, this would have been unthinkable and unnecessary. In the NHS of today it is thinkable. For the NHS to reach tomorrow it is necessary.