What’s the cure for an ailing NHS? You won’t find it in birthday soundbites from politicians

‘Is the present NHS, free at the point of service, worth it, given the rationing by delay?’ Ealing hospital in London. Photograph: Jeff Moore/PA

Everyone agrees that Britain’s 75-year-old NHS needs rescue and overhaul. But what does this mean? Surgery, therapy, the oxygen of cash, a slap in the face or just a hip replacement? And how is this to be decided? At that point agreement ends. There is silence.

This week the former health secretary Sajid Javid said the service’s current structure was “unsustainable” and in need of a royal commission. His successor, Steve Barclay, disagreed. The NHS, he said, was so “treasured” that it needed evolution, not a “big bang moment”. Labour’s health spokesperson, Wes Streeting, said the NHS had no need of a commission, “it needs a Labour government”. If no one can agree on how to search for a solution, the chance of finding one must be nearly zero.