As we mark the NHS’s 70th anniversary, how has the service evolved, and will it see another seven decades?
When Health Minister Aneurin Bevan presented his National Health Service Bill to Parliament in 1946, he laid out his intent for what would become the NHS: “Not only is it available to the whole population freely, but it is intended . . . to generalise the best health advice and treatment”. When the NHS came into existence on 5 July 1948, Bevan declared it “The biggest single experiment in social service that the world has ever seen undertaken.”
The NHS was originally based on three core principles:
- that it meet the needs of everyone
- that it be free at the point of delivery
- that it be based on clinical need, not ability to pay.
Then in March 2011, the Department of Health published the NHS constitution, which sets out seven guiding principles of the NHS, and each person’s rights as an NHS patient. It promised an accountable NHS which would aspire to the ‘highest standards of excellence and professionalism’, provide value for taxpayers’ money, and provide the fairest and most sustainable use of its finite resources.
We asked two people who have worked within and with the NHS for their views on how the health service has evolved, what state it is in now, and what the future holds for this venerated institution – is it sustainable and if not, what’s the alternative?
A political choice
Nottingham GP Dr Ian Campbell
I’ve spent my entire career working for the NHS, 35 years so far, and I’ve never known such a difficult time. I used to be proud of the service we offered, now I’m ashamed. The founding principles have been forgotten, with the service being more fragmented than ever and the inequalities that this creates being greater than ever before.
The NHS is a rationed service. There is no escaping that.
But more than ever we are being compelled to make clinical decisions based on cost; not ‘best-value’, which is a positive attribute, but simply cost – ‘can we afford it?’. Ultimately, when services are rationed, reduced, or removed, people lose out. And those that lose the most are those that can’t afford to pay for private services themselves.
It used to be that people used private healthcare to save waiting times; now it’s to access services that are no longer available on the NHS. Podiatry is a simple example; its nigh impossible to get podiatry for patients, even if they are blind! Fertility services are under direct threat. The waiting time for life saving surgical procedures such as heart surgery is rising rapidly, a few years ago measured in a few weeks, it is now back to around six months, which is where it was 15 years ago.
We are told this dire situation is down to more patients needing more care; sure, it is in part. But it is mainly due to cuts in the NHS budget. A 1% rise in government spending annually for the past seven years, compared to an overall average of 5% per annum.
A good, efficient, well-funded, high quality NHS is a political choice – so too therefore is an underfunded, under-staffed and overwhelmed NHS. We do have a choice.
The leadership of the NHS is culpable, for sure, but ultimately they are simply delivering what their political masters tell them to. I hear senior management describe the way they are treated as “bullying”. But at some point, the defence of just obeying orders fails to cut it. Those of us working within the NHS need to speak out, as we are increasingly doing, until the public realise that their 70-year-old NHS is being slowly, and quietly stolen from under their feet.
Bevan would be proud of those working within the NHS today, but ashamed of the level of service they are able to provide. And so too am I, an NHS doctor for 35 years. The next 70 years? Unless we have a radical political rethink I fear we will be lucky to see another 10.
Demand outstrips supply
Tim Warren, Managing Director, Triducive
The NHS is a world-renowned organisation and something to be extremely proud of. It has welcomed many lives, saved many lives and improved many lives.
It is 70 years old and has led innovation, advice and care during its long history. But it is broken.
The political parties exploit the NHS to win votes or influence Brexit. The NHS is an increasingly fragmented organisation, which is struggling to recruit staff and optimally care for a growing and ageing population, especially with many people now living with chronic diseases. The demand for the NHS has simply outstripped the supply. Just try getting an appointment with your local GP.
There are numerous organisations within the NHS, such as CQC, ICS, STP, CCG, primary care, secondary care and commissioning and it is fair to question whether they all share a common goal and measure of success.
Aneurin Bevan had a clear mandate for the NHS when it was conceived over 70 years ago, but how sustainable is that for the future?
The NHS must NEVER lose sight of the patient, but can the NHS remain free at the point of entry? I wonder if Aneurin Bevan would build the NHS in the form that it is in today? The sentiment surrounding the NHS is valid and real; but pragmatism must prevail over the next 70 years.