Chancellor Reeves tries to justify new taxes on farmers and others by insisting they will fund the NHS. So, once again, government throws huge sums at the NHS, without the necessary reforms both to the financial and management structure. We continue to go backwards.

The Chancellor needs to ask of this vastly funded service and of alternatives abroad: where is it that we find the longest queues for health services? Where do we see the highest rates of death from undiagnosed or untreated cancers? Which European countries experience the greatest and most institutionally endemic service delays, service denials, and outcome deficits? Where is rationing the most severe? Where do we find the most exhausted doctors and nurses? Where does productivity fall even when investment increases? Why does the injection of large new sums of money into health services seemingly make no differences to productivity or to management, or to improved outcomes and consumer satisfactions?

Compared with mixed-financial systems in Australia or on the European continent the picture for the NHS remains depressing, and distressing. Many still die early and unnecessarily from undiagnosed or untreated conditions.

The Chancellor also needs to ask why the public sector should be more efficient than the private sector. Of course, they are fundamentally different in terms of organisation and outputs.

The public sector is always politically directed. The private sector is instead directed by willing decisions made by consumers. The response of NHS crisis is to demand more money and to add more staff, including more bureaucrats. But the higher productivity of the private sector is surely due to the necessary responses in managing resources to satisfy the wishes of consumers. Private sector providers direct their energies, in the free market, to provide those services which will be most rewarded by consumers. This is a genuine measure of the importance which consumers place on them. The free market directs and uses scarce resources more productively. The measure of public sector activity by the Starmer government (and by predecessors of all parties, alas) is to merely add up numbers. The chief government measure of NHS outcomes is how much it spends! Uniquely in the NHS economy there are no sufficient measures of satisfaction or outcomes. What measures we do have on patient clinical outcomes when compared with other countries in general show the NHS at or near the bottom of most outcome tables.

The measure of private sector activities involve the qualitative matter of considering what consumers are willing to pay for. If all held a tax-based Patient Guaranteed Health voucher the same could be applied to all health and welfare services.

As policymakers reconsider the future of healthcare services, they surely need to address that a price-system is the only effective way to co-ordinate the decisions of the many productive units and of millions of consumers in society. Uniquely, prices signal this information. All patients can be financially empowered, with tax incentives and tax-paid vouchers, and supported by advice from charities. But a rationed, centrally-directed system will always deliberately limit access and delay or deny demand without stimulating supply. This is true even when demand is chronically in excess of supply – as the NHS so clearly demonstrates.

Prof John Spiers is the former Chairman of the Patients’ Association and the author of the books “Patients, Power and Responsibility: The First Principles of Consumer-Driven Reform” and “The Realities of Rationing: ‘Priority Setting’ in the NHS”.