NHS at 70: Celebration and Challenge
The 70th anniversary of the NHS is both a cause for celebration and a great challenge.
We should celebrate the fact that the NHS is a British success story. Its foundation represented a commitment that the post-war generation would find the resources to invest in a completely new and untested approach to health policy.
The commitment was to provide free access to care, but the ambition went well beyond that. Its purpose was to provide universal healthcare and secure what we now describe as healthy outcomes for citizens.
Aneurin Bevan put it this way in his book In Place of Fear:
“Preventable pain is a blot on any society. Much sickness and often permanent disability arise from failure to take early action, and this in its turn is due to high costs and fear of the effects of heavy bills on the family….
“Society becomes more wholesome, more serene, and spiritually healthier if it knows that its citizens have at the back of their consciousness the knowledge that not only they themselves, but all their fellows, have access to the best that medical skill can provide.”
Bevan described his ideas as socialism in action but support for the principle of universal healthcare goes well beyond those who would describe themselves as socialists.
Take but one example; The Economist has been a champion of British liberal thought since 1843, but in April this year it argued in its main editorial that universal healthcare is “sensible, affordable and practical” and that there is a “principled, liberal case for universal healthcare.” The front cover of the same edition proclaimed the objective “Within reach – universal healthcare, worldwide.”
So, when we celebrate 70 years of the NHS, we celebrate an idea which has developed its own life – independent of its political roots. It has won endorsement across the political spectrum, and across a wide range of social and cultural divisions, at home and abroad.
When Danny Boyle celebrated the NHS in the opening ceremony of the London Olympics he was celebrating a unique British achievement, but he was also celebrating an idea which has the same universal appeal as the Olympic ideal itself.
But celebration is like a drug; it can dull the senses and undermine our capacity for clear thought. It is right to celebrate the achievements of the NHS, but then we must move on to challenge ourselves to ensure that the principles of universal healthcare are properly applied for the next 70 years.
That is partly about money and the Government’s commitment to increased resources for the NHS over five years represents an important step forward. But although it is welcome, the government’s commitment to growing resources for the NHS is only a partial answer to the challenge.
Earlier this year the IFS and the Health Foundation published a joint report, sponsored by the NHS Confederation, which analysed the financial requirements of the health and care sector over the next 15 years. Their report was widely recognized to the most authoritative recent analysis of this subject and concluded that the resources available for health and care services need to increase by 4 per cent per annum if rising demand is to be met.
Measured against this analysis, the Government’s announcement falls short on two counts.
Firstly, if we look past the spin and compare apples with apples (i.e. we include the amounts required for training and equipment) the government has promised 3 per cent per annum to the NHS. That is a substantial sum and more than it has received since 2010. However, it is less than the long run trend of NHS spending, and – critically – less than the IFS analysis shows is required if the NHS is to meet the demands placed upon it.
Even more seriously, however, the IFS confirmed what everyone who works in health and care services already knew. The NHS cannot improve outcomes for citizens and deliver universal healthcare if it seen in isolation from the rest of local public services, and from social care in particular.
The government’s announcement, therefore, repeats the mistake which has been made by successive governments throughout the history of the NHS of believing that the commitment to deliver universal healthcare is made simply by supporting the NHS.
If it is to be successful, the NHS must be part of the fabric of local services, linked to social care, social housing and other services. When they fail, citizens suffer an unnecessary and avoidable deterioration in their quality of life and demand is diverted to the NHS.
The challenge facing the NHS of the next 70 years is to learn these lessons and work more closely with other public services to deliver improving health outcomes.