Reform UK: A clear threat to our NHS and the health of the nation

John Puntis explores Reform’s views on the NHS, arguing that Farage’s party poses a strong threat to the health service

The vast majority of the population see the NHS as a vital public service and wish it to continue to be publicly provided; 89% want care to be free at the time of use, and 81% favour funding from general taxation. While Labour is currently doing its best to persuade people that its policies on the NHS are really making a positive difference, objective facts suggest that promised targets will not be met. As a consequence, deteriorating performance driven by chronic underfunding has been fuelling demand in the right wing press for a change in funding model. Reform UK has risen in the polls with the real possibility that it could be in government after the next election. What might this mean for all of us in terms of access to health services?

What Reform UK leaders say about the NHS

Reform UK has pledged to keep health care ‘free at the time of delivery’ but also advanced proposals that would undermine and weaken the NHS as a public service. Party leader Nigel Farage has said in the past that we are going to have to move to an insurance-based model for funding the NHS, and has held up the French system as an ideal. Farage has clearly stated ‘Everyone knows we are not getting value, let’s re-examine the whole funding model and find a way that’s more efficient.’ He is also the chair and a co-founder of Action on World Health, which campaigns to reform or replace the World Health Organization (WHO), arguing against its global role in promoting and defending public health.

Richard Tice, deputy leader of Reform UK has argued for major ‘reform’ of the NHS, saying that the increasing numbers on waiting lists despite a boost to funding proves this is needed. He claims that current funding is adequate but money is mis-spent. Tice has said that Reform UK would bring NHS waiting lists (currently 7.3 million) down to zero in two years and suggested this could be done by making more use of the private sector and through ‘efficiency savings’, costing the pledges at £17bn a year. He also claims that abandoning net zero targets could save money that would then be used for the NHS, while failing to acknowledge the huge health care costs that will be driven by climate change.

Since being thrown out of Reform UK, Rupert Lowe MP has set up his own hard right party ‘Restore Britain’. While still a Reform MP, he declared ‘The NHS is a fraud…We should be allowed to opt out of the NHS and have some form of…scheme where we buy our own healthcare’. Lowe wants the NHS to be ‘dismantled and reassembled’. Such a massive change in model of care would not only involve huge costs but put health care beyond the means of many people (current per capita spending in England is £4,336).

James Bembridge, a Reform UK candidate for the 2026 local elections in London also seems to share Lowe’s visceral dislike for the service, saying ‘hate is too weak a word for what I feel towards the NHS. I’d tear it down and salt the earth upon which it stood’.

Reform UK’s plans to ‘reform’ the NHS

Reform UK’s 2024 manifesto, ‘Our Contract With You’, was described by critics as ‘Liz Truss economics on steroids’ after it promised £140 bn in tax cuts including raising the threshold of income tax to £20,000, and claimed that £156 bn could be found through making spending cuts. Reform UK now says that its ‘contract’ should no longer be taken as specific policy but rather ‘more as the philosophy of what the party wants to achieve’. The 2024 ‘contract’ together with the statements by Reform UK leaders give a good idea of what might lie in store for the NHS were they to gain power.

The ‘contract’ contained these proposals:  

• use independent healthcare capacity; harness independent and not-for-profit health provision in the UK and overseas
• tax relief of 20% on all private healthcare and insurance; this will improve care for all by relieving pressure on the NHS; those who rely on the NHS will enjoy faster, better care; independent healthcare capacity will grow rapidly, providing competition and reducing costs
• put patients in charge with a new NHS Voucher Scheme; NHS Patients will receive a voucher for private treatment if they can’t see a GP within 3 days, for a consultant it would be 3 weeks, for an operation, 9 weeks; services will always be free at the point of use
• improve efficiency; cut waste and unnecessary managers; operating theatres must be open on weekends; rotas must be planned further in advance; nail down better prices using economies of scale

This plan to use taxpayers’ money to expand private healthcare services was criticised by Daniel Goyal, writing in Byline Times:  ‘Keeping the NHS free at the point of demand is not the same as ensuring it is a tax-funded, publicly owned, universal healthcare system. The important question is whether patients can access the right medical treatment at the right time and without facing financial hardship’.

Reform UK’s proposals would have the effect of progressively replacing public ownership of healthcare with private provision funded by taxpayers, and lead to a two-tier system with inferior services for those without the means to pay for better. It could not deliver the promised ‘faster and better care’ in an NHS that would become increasingly under-resourced. Shifting care to the private sector undermines NHS services rather than ‘relieving pressure’. There is no evidence that competition among independent providers drives down costs.

Moving to an insurance-based system would increase costs

European countries with insurance-based systems spend much more on health care per head than the UK (France 26%, Netherlands 28%, Germany 32% and Switzerland 89%) including on higher administrative costs. If the UK had matched France in funding per head on health over the ten years before the Covid pandemic, the NHS wold have received an additional £40bn to spend each year. Arguments against a social insurance model of the type advocated by Farage have been summarised by the King’s Fund and include that it does not provide universal coverage and has higher administration costs. A recent analysis by the IPPR (Institute for Public Policy Research) across 22 high-income countries concluded that switching the NHS to a European-style insurance system would not improve performance across measures of capacity, access, quality, efficiency and equity.  A tax funded system is cheaper for patients so that if the NHS were to become like the French system, overall costs would rise and people would pay more out of pocket.

In France, not only are costs higher than the NHS, but people pay to see a GP (€30 each visit) and for time spent in hospital (‘hotel costs’). Many have to pay for top up health insurance as well as contributing to the costs of care. There are no positive health gains linked with moving to a social health insurance system. Lord Darzi pointed out in his report on the state of the NHS: ‘Every advanced country has universal health coverage (except USA) but other health system models—those where user charges, social or private insurance play a bigger role—are more expensive.’  Politicians like Farage who advocate moving to an insurance based model are not being honest, as it would increase costs without delivering benefits.

Efficiency savings

The NHS is constantly making efficiency savings, but while nominal spending continues to increase, spending related to health needs has decreased. It is this underspending that has led to poorer services and now poses a threat to the economy. While there may be examples of waste in the NHS, as in any big organisation, it is very unlikely that this explains poor services. The comprehensive international comparisons in the Commonwealth Fund reports rated the NHS very highly on ‘administrative efficiency’ (low billing, less bureaucracy, simpler paper work). As recently as its 2014 report the NHS was rated best overall. Research by the King’s Fund also found that the UK health service is amongst the most efficiently run healthcare systems. The Organisation of Economic Cooperation and Development noted that the NHS shows high efficiency in administration, spending significantly less on overheads (roughly 1.9% of health spending) compared to peers like the US (8.9%) and France (5.5%). Lord Darzi concluded that the NHS is not just short of money but has been systematically underinvested in capital (in fact a £37 bn funding gap), leaving it with outdated infrastructure that limits productivity, capacity, and quality of care.

As with potential efficiency savings in the NHS, before the 2025 local elections Reform UK claimed it would ‘reduce waste and cut your taxes’. The reality however is that for Reform UK led councils, council tax was increased on average by 3.94%, just lower than the overall average national rise of 4.86%. Reform’s failure to reduce taxes was spun by Richard Tice who claimed a £45m ‘reduction’ had been delivered. This misleadingly compared actual tax rises with what the figure would have been if a 4.99% rise had been imposed. No Reform UK council delivered a cut in council tax in cash terms. Just as its dream of making savings in local government through its Department of Government Efficiency unit evaporated when it collided with the reality of running a council, the same outcome is likely when savings are sought in the NHS.

Public health would be a disaster under Reform UK

Before the end of the Covid pandemic, Farage and Tice argued it was ‘time to redirect our energies’, insisting Britain should ‘learn to live with the virus, not hide in fear of it.’ Public health was reframed as a matter of individual choice rather than collective necessity. This was clearly a huge misjudgement. Research by Imperial College London estimated that the first national lockdown saved more than 470,000 lives. The Hallett inquiry concluded that introducing restrictions just one week earlier could have prevented an additional 23,000 deaths in England during the first wave. It is frightening to imagine what might happen during the next pandemic if Reform UK was in charge, particularly since one third of Reform UK councillors have expressed vaccine scepticism with some promoting conspiracy theories.

Globally, across most authoritative scientific institutions there is agreement that the climate is warming, human activities are the dominant cause and the risks increase as warming increases. The health costs of climate change are potentially immense. The biggest blind spot in terms of science, public health, and our future survival is Reform UK’s climate change denial. It has pledged to scrap net zero policies and argues that CO₂ targets are unaffordable and unachievable. Across England, councils led by Reform UK have been scaling back climate commitments at the very moment climate risks and the costs of fossil fuel dependence are intensifying. As with the pandemic, it is ludicrous that both climate change and its implications for public health are not acknowledged by Reform UK.

Conclusions

Reform UK poses a major threat to our health services and to public health. Its policies, if implemented, would drive the NHS towards a two tier system, directing public money to investment in the growth of the private sector. The social determinants of health which most disadvantage the poor and ethnic minorities are ignored, as are health inequalities. It has no convincing answer to current waiting lists, accessing a GP and the crisis in corridor care.  Its anti-immigration stance risks precipitating a huge staffing crisis in both the NHS and care services.

Labour needs to distinguish itself from Reform UK by committing to the founding model of the NHS, pointing out that this is proven to be more efficient and cheaper than a social insurance system. It should also commit to getting private providers out of the NHS, an increase in overall funding to levels more like those in comparable European countries, and the recruitment and retention of well-trained staff in order to be able meet the health needs of the population. Public health and the social determinants of health must be placed high on the agenda and funding aligned with meeting need. Failure to deliver on its promises to improve the NHS will only further the support for the rich business men in Reform UK intent on selling their particular brand of snake oil.