Britain's Sacred Cow

A genuinely cross-party phenomenon

The description of the NHS as "the closest thing the English have to a religion" is usually attributed to the former Conservative Chancellor Nigel Lawson, and the label has stuck because it's accurate: criticism of NHS funding levels or day-to-day performance is common and unremarkable, but criticism of the underlying model — how it's funded, structured, staffed, and held accountable — is treated as close to a political third rail by every major party. It's worth being precise about what this claim is and isn't. Politicians criticise NHS performance constantly and often ferociously — Andy Burnham himself, as Shadow Health Secretary in 2015, called a bad quarter of A&E figures a "crisis." The pattern this article is describing is narrower and more specific: performance criticism rarely translates into structural reform of how the institution is run, staffed, or held accountable when it underperforms, and no mainstream party — including Reform, which is otherwise comfortable attacking institutions few others will touch — proposes changing that.

This isn't a new observation, and it isn't uncontested. The Nuffield Trust has argued the opposite case: that the NHS has actually had far too much reform, of a badly designed, structurally focused kind, and that the "sacred cow" framing is sometimes used to wave through changes that were never properly evaluated. Both things can be true at once, and this article's argument depends on holding them together: the NHS has seen constant reorganisation of its structures, while seeing remarkably little sustained discipline applied to its day-to-day operational performance — the two are not the same kind of reform, and conflating them is part of how the accountability gap stays hidden.

What has been spent, decade by decade

Public support for the NHS is often described as unconditional, but the money behind it has never been. Since 1979/80 alone, the Department's budget has grown roughly four-fold in real terms and has doubled as a share of GDP — but that growth has been erratic, not steady, shaped as much by political choice as by need.

Figures for GDP share are approximate and drawn from Nuffield Trust and King's Fund analysis, which sometimes differ slightly depending on exactly what is counted as NHS versus wider health spending; absolute figures are cash terms unless stated. The Department of Health and Social Care is today the largest single government department and the second-largest area of all public spending, after welfare.

Reviews, governance, and who actually gives the NHS its instructions

The NHS is funded through general taxation and run, formally, through the Department of Health and Social Care — a government department headed by the Secretary of State, who sets an annual mandate specifying the service's priorities and the money attached to them. In practice, the chain of command has been rebuilt so often that describing "how the NHS is run" accurately depends entirely on which year you're asking about.

The most consequential episode is also the most recent. In March 2025, Prime Minister Sir Keir Starmer announced the abolition of NHS England — the arm's-length body that had commissioned, planned and funded the health service since being established by the 2012 Health and Social Care Act — with its functions folded back directly into the Department. The government's own language was blunt: NHS England was "the world's largest quango," had become "bloated" at a cost of almost £2 billion a year to run itself, and its distance from ministers had "reduced" democratic accountability and control. The Health Secretary's justification for reversing a reorganisation his own party had lived with for over a decade was equally direct: "we need more doers and fewer checkers." Around 9,000 jobs are being cut as part of a target to halve the combined NHS England and DHSC workforce.

This is worth setting against the fuller history. The 2012 reorganisation that created NHS England was itself, in the current government's own words in Parliament, "the disastrous 2012 reorganisation, which led to the longest waiting times, lowest patient satisfaction and most expensive NHS reorganisation in history." Before that, the 1991 internal market split the NHS into purchasers and providers; before that, the 1983 Griffiths Report introduced general management for the first time, replacing consensus decision-making with individual accountability, precisely because ministers judged the service too diffuse to be steered; before that, the 1974 reorganisation was so widely criticised for adding layers of bureaucracy that it became known at the time as "tears about tiers." Each reform was sold as the fix for the last one's failures. None has yet produced a structure that lasted much more than a decade before being judged to need reversing.

The 2025 abolition itself is, as of this writing, already behind its own schedule and drawing exactly the criticism this article documents elsewhere. The Institute for Government's one-year assessment, published in 2026, found the transition had been handled poorly from the outset, quoted a senior civil servant describing the process as "utter chaos," and noted that "the benefits have yet to materialise" — with full completion now pushed back to April 2027, two years after the announcement. This is the same pattern this platform's Lies, Misleading, Omission and Denial article documents in the civil service headcount case: a confident structural announcement, followed by a slower, messier, less accountable delivery than promised, with the public left to take the eventual benefit on trust.

The deeper point is the one Nuffield Trust researchers have made directly: the NHS has had no shortage of governance reform. What it has had far less of is sustained operational discipline applied consistently between reorganisations — which is exactly why the sickness absence, A&E, maternity, and negligence figures set out below have been able to persist and worsen across multiple different governance structures, several different parties in office, and at least five distinct national reorganisations since 1974. Restructuring the org chart has repeatedly substituted for the harder work of enforcing performance within whatever chart currently exists.

What the absence of scrutiny actually looks like, in numbers

Staff sickness absence

NHS sickness absence stood at 5.0% in April 2026 and 5.7% in January 2026, against a UK private sector average of around 1.7–1.9% in 2025 — roughly three times higher. Measured in days lost per worker rather than as a percentage, the gap is starker still: around 8.6 days per worker in health versus 3.8 days in the private sector. A cross-party-endorsed 2026 report, NHS, Heal Thyself, described the trend as having reached "unsustainable levels," noting long-term sickness absence (over 28 days) up 43% between 2019 and 2024, and the number of staff going on long-term sick leave and never returning up 42% over the same period. Some of this gap has a legitimate explanation — the NHS workforce is older and more female than the private sector average, both correlated with higher sickness absence independent of management quality, and staff face genuine infection exposure and physically and emotionally demanding conditions that most private sector roles don't. That context matters and shouldn't be erased. But it doesn't fully explain a threefold gap, and the more telling detail is what caused it: anxiety, stress, depression and other psychiatric illness now account for close to 30% of all NHS sickness absence — a symptom of a system under sustained pressure that has had eleven years to design and roll out a serious staff wellbeing and occupational health strategy, and by its own regulator's account, still hasn't.

A&E: the target was lowered, and the lower target is still being missed

The original four-hour A&E standard, set in 2010, required 95% of patients to be admitted, transferred or discharged within four hours. That target has not been met nationally in years. Rather than closing the gap, NHS England's own planning framework for 2026/27–2028/29 sets a formally reduced objective of 82% — and even that lower bar isn't being hit: 76% of attendances were seen within four hours in May 2026. The median wait time across all A&E patients was 2 hours 59 minutes in March 2026 — worse than the pre-pandemic peak of 2 hours 54 minutes recorded in December 2019, meaning the system is now performing below its already-declining pre-COVID baseline. In June 2026 alone, 49,000 patients waited on a trolley for over 12 hours after a decision had already been made to admit them — a 7% increase on the same month the previous year. This is not a story of a target narrowly missed; it's a story of the target itself being revised downward to something closer to what the system can actually deliver, with limited public debate about whether that revision was ever properly put to the country as a choice.

Maternity care: "poor care had become normalised"

The Care Quality Commission's national review of maternity services in England, covering 2022 to 2024, is unambiguous. No maternity service inspected was rated 'outstanding' for safety. 47% were rated 'requires improvement' for safety, and 18% 'inadequate' — meaning fewer than four in ten met a basic safety bar, let alone excelled at it. The review's central finding was that failures were "widespread rather than isolated to the high-profile scandals reported on" — a direct statement that the well-known cases (the Ockenden review into Shrewsbury and Telford, the East Kent "Reading the Signals" report, and an ongoing independent investigation into Nottingham University Hospitals, running alongside a separate police investigation) are not outliers but symptoms of a system-wide pattern. A further national investigation into maternity and neonatal services, chaired by Baroness Valerie Amos, was launched in June 2025 and is still under way. Reviews of this scale and seriousness are the right response to genuine harm — but it is worth asking plainly why it takes this many separate scandals, over this many years, before a sector-wide safety failure gets a sector-wide response, rather than the pattern being caught and corrected the first time it was documented.

Social care integration: the blockage everyone names and nobody has fixed

Patients who are medically fit to leave hospital but cannot be discharged because social care isn't available to receive them — "delayed discharges," more bluntly known as bed-blocking — remain a persistent, named problem raised repeatedly in Parliament, with ministers still describing the issue in early 2026 in almost identical terms to how it was described years earlier: limited social care bed capacity, staff shortages, and poor coordination between the NHS, local authorities and social care providers. An independent review led by Baroness Louise Casey into the future of adult social care is under way, with its first phase not due for implementation until mid-2026 at the earliest — meaning a problem that directly clogs NHS hospital capacity, and that has been publicly acknowledged for the better part of a decade, is still, as of this article, in the review stage rather than the delivery stage.

Dental access

NHS dentistry access has deteriorated to the point that "dental deserts" — areas where finding an NHS dentist accepting new patients is effectively impossible — is now a standard term in health policy debate rather than a fringe complaint. Government has committed £111 million a year and pledged 700,000 additional urgent dental appointments to address it, alongside a long-promised dental recovery plan. Whether that specific pledge is delivered in full is worth tracking with the same discipline this platform applies to every other government promise — but the starting point is already telling: a service most people assume is part of "the NHS" in the way GP or hospital care is has, for a large share of the population, effectively stopped functioning as a free-at-the-point-of-use service at all.

The clinical negligence bill

This is the figure that most directly translates poor safety outcomes into a number the public can actually weigh against other spending choices. The annual cost of clinical negligence claims against the NHS quadrupled between 2006–07 and 2019–20, from £600 million to £2.3 billion. More strikingly, total clinical negligence liabilities — the full future cost of claims already recognised, including the very long-tail cases such as birth injuries that can take 11–12 years to resolve and cover a lifetime of care — have grown from £9 billion in 2007 to more than £82 billion. The National Audit Office's own assessment, cited by the Commons Health and Social Care Committee, found that government has had no coherent strategy for reining these costs in. £82 billion in recognised future liability is not a rounding error against this platform's own £110 billion annual debt interest bill — it is a genuinely comparable-scale sum, driven substantially by exactly the kind of safety failures documented above, and it has grown for two decades with no serious cross-party plan to bring it under control.

A question worth asking honestly: what should stay free?

None of the failures documented above are really about the founding principle that care should be free at the point of use for anyone who is ill — that principle has broad, durable public support and this platform isn't arguing against it. But the NHS has, over decades, absorbed some things that sit at the edge of what "essential healthcare" originally meant, without ever holding a serious, explicit debate about where that edge should sit. A modest, means-tested charge for GP visits, with full protection for anyone vulnerable or on a low income, is one version of that conversation; a clearer, published line between diagnosis and treatment that is always free and genuinely discretionary procedures that could reasonably carry a fee is another. This platform is not proposing a specific list here — precisely because getting that list right requires the kind of careful, clinically-led judgement a short article can't responsibly substitute for, and a badly drawn line risks penalising people with genuine need rather than genuine discretion. But the absence of any serious public debate about where free-at-the-point-of-use should end is itself part of the sacred-cow pattern this article describes: even raising the question is treated as an attack on the principle, when it's really a question about scope, asked nowhere near seriously enough given the NHS's own resource constraints documented throughout this piece.

What an honest plan to improve would include

This platform's existing Public services: output, not just input item already sets out the fiscal case — a 2% annual NHS efficiency target, £14 billion in identified public service efficiencies, and up to £12 billion a year in achievable AI-driven savings, none of it yet enforced with real consequence. To that, this article adds four specific, evidenced asks. First, sickness absence management should be treated as a named performance metric with public trust-level reporting and a specific, time-bound target to close the gap with the private sector — not eliminate it, given the legitimate reasons some gap will always exist, but close it materially. Second, the findings of the CQC maternity review and the Amos investigation should carry mandatory board-level accountability at trust level, with a public timeline for every trust below 'good' on safety to reach it — not another round of reviews with no enforcement mechanism attached. Third, the Casey review's social care recommendations need a delivery date attached in statute, not just a publication date, given how directly delayed discharge constrains NHS capacity elsewhere. Fourth, NHS litigation reform — already under live consideration by the Health and Social Care Committee, including proposals to revisit the legal basis for calculating damages — deserves to be pursued to conclusion rather than left as a standing item successive governments acknowledge and none resolve, since every year of delay adds directly to an already-£82 billion liability.

None of this requires abandoning the principles that make the NHS popular. It requires treating operational failure with the same seriousness the country already, rightly, applies to fiscal failure — which is precisely the standard this platform tries to hold itself to everywhere else in this document.