Last week, at the annual British Labour Party conference, Health Secretary Alan Johnson unveiled a series of reforms designed to rejuvenate the country’s National Health Service (NHS) and make the socialized regime of medicine more “personalized.” It was the latest in a decade-long string of efforts by Labour to improve a public system that, almost 60 years after its creation, remains plagued by problems ranging from lengthy delays between referral and treatment, to rationing of referrals, to excessively high rates of hospital infection by the MRSA “superbug,” to dire financial woes that threaten to leave all these underlying problems unresolved for years to come.

Secretary Johnson’s prescription? Urge general practitioners to keep their offices open beyond normal business hours. Encourage pharmacies to offer blood pressure checks. Ensure that gyms dispense advice on the prevention of sports injuries. Set a target of reducing the presence of the MRSA superbug in hospitals by 50 percent through a new system of inspections and fines.

Given the overwhelming, large-scale problems evident in today’s NHS, these proposals seem like small ball—an effort to tinker at the edges rather than address the fundamental, institutional dilemmas beleaguering the system on which most Britons continue to rely exclusively for their health care. They also mark an abandonment of the deeper, more systemic NHS reforms pursued under former British prime minister Tony Blair.

Blair deserves credit for trying to improve the health system through greater private-sector involvement, even if his efforts did not result in a full-scale overhaul of the NHS. The Brown government has been far more timid.

Blair enlisted the private sector to provide services ranging from the conduct of MRI scans to the catering and cleaning of hospitals, all in an effort to boost NHS efficiency. He also pursued the so-called Private Finance Initiative (PFI), which was originally pioneered by the Conservative Party for the purpose of building and rebuilding hospitals with reduced strain on the public purse. He set targets for just about everything (waiting times included), with at least temporary success.

Of course, the Blair government also embraced age-old Labour strategies like raising new revenue through tax hikes and then throwing money lavishly, and wastefully, at a problem. Britain is projected to spend £40 billion more on the NHS in 2008 than it did in 2002, with much of the new money directed toward increased salaries for NHS administrators and schemes of dubious effectiveness, such the NHS Direct “telephone-a-nurse” service.

Still, Blair deserves credit for trying to improve the health system in Britain through greater private-sector involvement, even if his efforts did not result in a full-scale overhaul of the NHS. Secretary Johnson, and by extension the current British prime minister, Gordon Brown, who fought Blair over public-service reform while serving as chancellor, has been far more timid, advocating only minor tweaks that fail to address the root problems afflicting the NHS—problems that threaten its very existence.

A growing number of Britons view the NHS as simply broken. And more and more are seeking a way out.

Many NHS Trusts are saddled with more debt than they can manage. This is partly connected to the costs associated with PFI funding for hospital developments and redevelopments, since PFI schemes tend to cost more than ordinary, publicly-funded projects overall and Trusts are responsible for making the payments. However, it is also a function of Britain’s aging population. (For obvious reasons, the elderly require more medical care than the young.) According to recent projections, by 2031 there will be 53 percent more people over the age of 65 in the United Kingdom than there were in 2001. 

Increasing rates of obesity do not help, either. Nor does the 35 percent spike in emergency admissions between 1998 and 2005, or the fact that the system remains saddled with an onerous bureaucracy, adding many costs not directly related to the provision of care. The NHS budget is also being scaled back, which will almost certainly mean reduced service capacity.

A growing number of Britons view the NHS as simply broken. Indeed, more and more are seeking a way out. As The Financial Times recently reported, the number of Britons enrolled in private medical insurance policies has climbed to 7.4 million—more than 12 percent of the overall population. According to Nick Homer of Norwich Union Healthcare, the growth of private insurance can largely be attributed to the NHS’s dodgy “reputational issues.”

To be sure, the British political culture remains committed to salvaging its public-sector health service. But without genuine (and politically challenging) reforms, the NHS may eventually cease functioning as a workable system altogether. The new Labour government must come up with a more comprehensive plan than merely fining dirty hospitals and pressing gyms to offer advice on sports injuries.

Liz Mair is a recovering corporate finance lawyer, and a columnist, commentator, and political consultant operating out of Arlington, Virginia. She writes daily at www.lizmair.com, and lived in the United Kingdom for ten years.