By Thomas Sherlock
70 years ago today, the National Health Service (NHS) was established, with the aim of providing universal healthcare free at the point of use. Today it remains a foremost part of UK political discourse and a pillar of UK culture. On its 70th birthday, what is the state of the NHS?
From seeds planted in the Beveridge Report in 1942, taken forward into a White Paper by Conservative MP Henry Willink, the NHS was established under Clement Attlee’s Labour government. Its architect was Nye Bevan, who after struggling to win over the British Medical Association at first (infamously quipping that he had ‘stuffed their mouths with gold’) eventually launched it on 5 July 1948. At that launch three core principles were established that remain on the NHS’ website today:
-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
Fundamentally the NHS’ aims remain the same as 70 years ago. Today the NHS treats vast numbers of patients, with a NHS England report in October 2017 finding that in the last year almost 16 million patients had started treatment and there had been over 23 million attendances to Accident & Emergency (A&E).
The modern NHS faces problems; that is recognized across the political spectrum. The target of treating 95% of A&E patients within four hours of their arrival hasn’t been met in England since 2015. A&E services came under further pressure this last winter, with the Royal College of Surgeons blaming a lack of ‘adequate funding or capacity in our health or social care services’ for the problems. Waiting lists remain a frequent political talking point, with over 3.8 million people on waiting lists at the end of August 2017 according to NHS England statistics and new limits introduced in February meaning some patients could wait as long as three months for procedures. All of these problems look set to continue into the future owing to the ageing population, with the Office for National Statistics estimating that by 2044 nearly 25% of the UK population may be 65 and over. The NHS’ resources are increasingly stretched, as reflected in last week’s announcement to reduce or stop the commissioning of 17 minor procedures. How to ensure that the system of free care from cradle to grave manages these problems is one of, if not the, biggest conundrum of UK politics at present.
The most controversial move to sustain the NHS has been the involvement of private contractors. During 2016-17 private firms won nearly 70% of clinical contracts put out to tender in England, with NHS spending on care provided by private companies reaching £3.1 billion last year. The biggest is Virgin Care, which as of December 2017 had over 400 separate NHS contracts. To some this is privatisation by stealth, making the NHS reliant on private companies, to others it is a necessary measure to sustain the NHS. Richard Branson insisted in January that the aim of Virgin Care was to help the NHS, not make a profit. Regardless, private companies’ presence in the NHS will remain a source of controversy, and their presence alone is neither single-handedly creating nor rectifying the NHS’ problems.
As ever, different political parties have proposed different solutions. Recently the Conservatives announced an increase of spending from a Brexit dividend, the exact nature of which is disputed. Labour’s manifesto last year also promised more spending and halting of cuts, claiming they planned to invest in it for the future. The Liberal Democrats ran on a proposal of a penny-in-the-pound rise on all income tax bands and dividends specifically to fund the NHS, which they claimed would raise around £6 billion a year. I fear however that there is no silver bullet for the NHS’ problems. The pressures on the NHS are likely to remain fixtures of our political discourse. At best the solutions proposed by all parties can mitigate them, but I don’t believe they can remove them entirely.
I have only begun to get into the vast debate over the NHS, but let this not be a downbeat birthday message. The NHS is a fundamentally good thing which for 70 years has treated millions of patients. Is it flawed? Of course it is. It is facing problems? Of course it is. Despite this, the NHS remains as monumental an achievement now as it was 70 years ago. The ability to have healthcare for free should never be taken for granted. Happy Birthday.