The grand sweep can bring useful illumination – standing back from the day to day to see the big, long-term, trends. This thought ran through my mind as I listened to a former Department of Health insider discuss the current challenges facing the NHS at a recent dinner this week. The point he made was simple and powerful.

“Thanks to a decade of investment at unprecedented levels, we have lifted the NHS to the standards of other advanced Western democracies”

Go back 15-20 years and think what the NHS was like then. Decades of underinvestment; crumbling old buildings with dangerously low levels of maintenance; a service that could only survive by forcing patients to wait for vital treatment for months on end. No waiting time targets; mixed sex wards; underpaid staff. Public confidence in the NHS at record recent lows, for good reason. An NHS that felt like it belonged to the crumbling, ex-Soviet bloc rather than an advanced Western democracy.

Thanks to a decade of investment at unprecedented levels, the sheer effort of a committed workforce and the vision of a new government, we have lifted the NHS to the standards of other advanced Western democracies.

Our spending on healthcare per head of population now stands in comparison with our competitors. We have built new hospitals and properly reward our staff. For patients, waiting times have fallen rapidly; mixed-sex wards have been eliminated; and outcomes have improved dramatically. We have an NHS that we can be fiercely proud of.

Consequences of the funding gap

Our wise ex-DH insider’s punchline was that we need a public debate about whether we, as a nation, having worked so hard to reach this state, are happy to see a slow drift backwards. Because that will be the inevitable consequence of the £30bn funding gap we’ve all been talking about this week. You get what you pay for.

This debate clearly fits into a broader one on the role and place of the state in our lives, and how we pay for it. As our wise and experienced ex-permanent secretary pointed out, we can’t carry on providing a Scandinavian level of social provision on an American level of taxation.

So we need a proper national debate on how much we invest in the NHS and the kind of NHS we want to see. A debate with a degree of honesty, openness and reason that we seem to find difficult when we discuss health issues. And Mike Farrar, chief executive of the NHS Confederation, is right to argue the NHS needs to come together as one for once, to force this debate centre-stage as we approach the general election. 

So, congratulations to NHS England and Sir David Nicholson for an articulate and effective set of media performances this week around its new “call to action”. It felt like a good way to begin this vital public discussion.