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The NHS at 70: What’s the Future of Our Health Service?

It’s one of the single greatest creations and achievements in this country’s history.

Dan Peacock 

Naked Politics Blogger 

As a rule, I am not a hugely patriotic person. God save the Queen, pomp and circumstance, and rule Britannia are not words that appear often in my vocabulary. I just don’t have that gene (perhaps it’s distant my Irish roots).

There are however two things that make me patriotic:

  • The England Football Team during the World Cup
  • And the NHS

The latter turns 70 today having seen to its first patient Ms Sylvia Beckingham aged 13 on 5th July 1948. A cornerstone of the Beveridge Report, the vision of the NHS was to address what Sir William Beveridge saw as one of the five ‘Great Evils’ that engulfed post-war Britain: disease.

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Although not perfect, it is a vision and a mandate that the NHS has consistently delivered, and delivered amazingly, since day one of its existence.

In my view, it’s one of the single greatest creations and achievements in this country’s history. A public health service that strives to meet the needs of everyone, is free at the point of delivery and is based on clinical need not the ability to pay. As an institution it affirms the sacrosanct truth that health is a human right. Its care transcends class, race, gender and nationality and it is staffed by wonderful individuals who demonstrate to us mere mortals the very meaning of public service. 

Although a brief look at the history books will tell you that Britain has little to be proud of, the NHS makes me unequivocally proud to be British. It is a British masterpiece.

This has nothing to do with ideology, and everything to do with meeting basic human needs. The NHS should not be political.

However, for as long as it’s been around, politics has continued to get its grubby hands on the NHS. As long as it has existed, it has been subject to mismanagement, lack of care and existential threats posed by those who would see it destroyed for the sake of ideological purity.

These threats are as acute today as they have ever been; the NHS is currently in a critical condition.

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It is grossly underfunded. Since 2010, real-terms funding to the NHS has not kept up with rising running costs, rising demand for its services, an ageing population and a desperate lack of social care post-discharge. In 2013, NHS England stated that it faced a funding gap between current levels of resources and what it needs to keep up with demand to the tune of £30bn by 2020, even if spending increased with inflation.

The government’s response: demand the NHS make 22.5bn in efficiency savings, a squeeze that has continued for 5 long years.

The result of starving the NHS of funds is worse care and fewer services, and this deterioration in the quality of care can be witnessed across NHS Trusts nationwide.

Five years on, only now has has the government decided to radically increase funding, promising an extra £20.5bn until 2023/24 through an urban myth called the ‘Brexit Dividend’. This represents a real-terms increase of approximately 3.4% a year. Problem solved, right?

Although a welcome increase, health experts have concluded that this only constitutes the bare minimum required to stop the rot, and according to the Health Foundation it is ‘simply not enough to address the fundamental challenges facing the NHS, or fund essential improvements to services that are flagging…”. They recommended increases of at least 4.% a year.

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It is also understaffed. There are at least 92,000 staff vacancies in the NHS, and according to the Health Service Journal an estimated 96% of hospitals have nurse shortages. Systemic low pay, low morale and unmanageable levels of stress are some of the reasons cited for this staffing crisis.

Put simply, unprecedented numbers of people – talented, devoted, and caring people – no longer want to work for the NHS. And all roads lead to the government.

Worst of all, its core founding principles are being dangerously compromised. A service designed to be free at the point of use and take health out of the marketplace, is being slowly and subtly marketised. Creeping privatisation of the NHS is not a new phenomenon; the outsourcing of NHS services to the private sector has been practiced for years now with services such as dentistry, optical care and pharmacy being provided privately, and it began with Blair and Brown’s Labour administration.

Now it is important to say that the proportion of NHS services being provided by private firms is still relatively small, it is still free at the point of use, and as the Kings Fund recently concluded, it is an exaggeration to state the NHS is being wholesale privatised. We are still many leagues apart from the frankly morally rancid health system that exists in the United States, which, to quote Shadow Health Secretary Jonathan Ashworth, “checks your purse before it checks your pulse”. The NHS is still the NHS, and improved patient choice and scrutiny can be a healthy thing.

However, this continued and quickening drip-feeding of market logic into the NHS is hugely problematic.

Firstly, by definition, private firms are profit motivated. Whilst there is nothing inherently wrong with profit, when it is required to coexist with a public good like health, conflicts of interest can arise, and there are times when one has to be compromised to the detriment of the other.

Secondly, if the NHS was properly funded, competition and outsourcing would not be necessary. What the NHS needs is not a more diverse pool of more effective providers, but a more joined-up, integrated, adequately funded health system delivered by the NHS itself. Privatisation and increased competition is papering over the cracks on a macroeconomic scale.

Thirdly, it shows a complete lack of faith in the ability of the NHS to do what it has done so well for 70 years. The NHS is one of the best health services in the world. This sudden belief that private health providers can do it better is both unfounded, and an insult to an organisation that has led the way for decades. Let’s have a bit more confidence in our NHS.

So as the NHS reaches its 70th birthday, let’s take a moment to appreciate how unbelievably fortunate we are to have it and recognise that the NHS itself has a health that needs looking after. As it continues to suffer from the crippling effects of underfunding, understaffing and market overreach, it is the responsibility of all of us who value it – irrespective of where you stand on the political spectrum – to always fight for it and ensure this sickness does not become terminal.

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