The NHS’s 75th birthday is cause for despair – not for celebration
The advancing years of the main-stage line-up at Glastonbury on Sunday were testament to the longevity of the baby boomer generation. Cat Stevens, aka Yusuf Islam, was born a few days after the foundation of the NHS, 75 years ago next week, and invited the crowd to shout out their thanks to the service. They duly obliged, but what were they cheering for?
Research published on Monday by the King’s Fund, a medical think-tank, said Britain’s healthcare system has far worse outcomes than almost all of its peers. It compared 19 major nations and found the NHS was second worst of all those examined for saving lives.
We have among the worst survival rates for cancer, heart attacks and strokes and our life expectancy is the second lowest, even falling between 2010 and 2020 while that in other countries increased. So the Glastonbury crowd were applauding a concept, not a properly functioning system, let alone one that can any longer be called “the envy of the world”, if it ever was.
The day the NHS was born, July 5 1948, was the third anniversary of Labour’s landslide post-war election victory. Its egalitarian ambitions had struck a chord within the country as a break with the perceived injustices of the past.
Free, universal health care was first mooted by Beatrice Webb, the Fabian socialist, in 1909. Two years later, David Lloyd George introduced a health insurance scheme, financed by contributions from employees, employers and the exchequer, but which covered only male workers earning less than ￡160 a year. Most working people remained dependent upon charity for hospital treatment; the better-off had to pay, but taxes were much lower.
The shortcomings of this system led policy-formers to revisit Webb’s idea. In 1926, a Royal Commission called for a medical service “supported from the general public funds”, the idea that Labour took up.
Had its political parents known it would grow over the next 75 years into a voracious adult with an apparently insatiable appetite for taxpayers’ money, perhaps they might have been a little more circumspect.
However, the idea of healthcare free at the point of delivery and funded almost entirely by the state has proved so strong over the years that any attempt to challenge that basic principle is considered a modern form of heresy.
This immunity to criticism was apparent even within a decade of its foundation. Writing in 1959, Harry Eckstein, a Harvard professor, suggested the health service was “accepted as an altogether natural feature of the British landscape, almost a part of the constitution”.
It is this talismanic quality that has made governments down the years so terrified of reforming the NHS – and opposition parties so adept at exploiting any shortcomings. Throughout much of that time, opinion polls consistently placed the NHS near or at the top of the list of voter priorities, and woe betide any party that fails to heed signs of dissatisfaction.
But people are no longer prepared to put up with the mythology. The British Social Attitudes Survey for 2022, published in March, came up with some startling statistics. Overall satisfaction with the NHS fell to 29 per cent, the lowest level recorded since the survey began in 1983. More than half of respondents were dissatisfied with the NHS and this was seen across all age and income groups, sexes and supporters of different political parties.
What is it that people want from a health system? We expect to be able to see a GP quickly and easily since they are the gatekeepers for the treatment available in the acute sector. If we collapse at home or in the street, we expect an ambulance to arrive quickly and take us to hospital. When we arrive, we expect to be offered a bed, not kept on the forecourt or decanted on to a trolley for hours on end. On the non-emergency side, we want appointments to be arranged within a reasonable time and for any required operations to go ahead when scheduled and not be constantly postponed.
It’s a measure of the NHS’s failure that, when Rishi Sunak was asked at the weekend to point to any successes, he singled out the reduction in two-year waiting times as if this is a milestone of which we should be proud. This week, he will seek to address another criticism, staff shortages. Over the years, a succession of disastrous decisions has contributed to this. Project 2000, which diverted nursing from hospital-based apprenticeships to degree courses, has made the NHS increasingly reliant on overseas staff.
Britain ranks below the average for high-income OECD countries in terms of the number of practising nurses it has and the annual number of nurse graduates relative to population. Furthermore, about 15 per cent of UK registered nurses were trained outside the UK – more than double the OECD average.
Why does anyone believe a new recruitment and retention plan will make any difference when previous efforts have foundered? As Einstein supposedly said, doing the same thing over and over again expecting a different outcome is insane.
The irony is that universal “free” care was meant to make us healthier, thereby gradually diminishing the demand for medical treatment, but the opposite has proved to be true. Increasing life expectancy means more people live to the age where they contract diseases that are expensive to treat. People are also less inclined to queue than they were in the more austere days of the 1950s and they want those new knees and replacement hips that are so expensive to provide.
AI, robotics and gene mapping will all help but are also likely to increase demand not lessen it. More funding can either come from higher taxes or from increasing the amount of private money in the system, through charging for visits to GPs and hospitals and encouraging the growth of social insurance schemes of the sort widespread on the Continent.
The reality is that we can only preserve a universal service by sacrificing another of the founding values of the NHS: free at the point of use. The younger people cheering on the 75-year-old NHS at Glastonbury will have to embrace a mixed-funding system or accept the inexorable deterioration of health care in Britain.