NHS @ 65: the NHS cannot do it alone

We are in danger of losing our collective nerve over the future of the NHS. In 1948, in the midst of austerity and post-war national exhaustion, Britain created a comprehensive health service which offered care to those who needed it regardless of their means.

It was a courageous idea whose time had come and it made compelling economic, political and social sense. It still does.

In 2013 our far richer country can and should continue to embrace Aneurin Bevan’s vision. Of course we face very different health challenges to those of 1948. We live longer; there are more people with disabilities and long-term conditions; there are more very old people. More health care is delivered to more and more people. It has become eye-wateringly expensive.

These, by the way, are largely the fruits of success: decades of rising prosperity and advances in public health, medicine, surgery, pharmacology and technology. Many millions of people have cause to be thankful.

Through a mixture of defeatism, lazy thinking and, in the case of some, malign intent, we are in danger of sleepwalking towards dismantling the NHS

The NHS, as so vividly highlighted in the opening ceremony for the 2012 Olympics, has become woven into our national myth. Opinion polls consistently show it to be popular and well supported.

And yet in policy-making circles the prevailing mood in 2013 is one of gloom. People fret about ‘rising demand’ and the ‘burden’ of chronic disease. Hand-wringing about the sustainability of A&E services is the latest fashion as I write.

A scandal in one hospital in Stafford has prompted an unending spasm of inquiries, reviews and navel-gazing about the capacity of the entire NHS to deliver care safely and with compassion.

It has become fashionable to blame patients and the public for profligate use of the NHS. We are eating, drinking and slobbing ourselves to early graves at the taxpayers’ expense, failing to ‘self-care’; wasting GPs’ time; and rolling up to A&E with trivial complaints.

And in this current economic slump it is becoming fashionable, for the first time since the 1980s, to question whether Bevan’s settlement – a comprehensive service, free at the point of use – is sustainable and affordable.

Through a mixture of defeatism, lazy thinking and, in the case of some, malign intent, we are in danger of sleepwalking towards dismantling the NHS. Of course there is a lot that needs change and improvement. In ten years’ time, a functioning NHS will need coordinated out-of-hospital services for the very old; it will need patients who are informed, engaged and when necessary stroppy; and it will need a more social and less medical, less pharmaceutical model of care.

Before 1948, the great scandal was that your health care depended on the size of your wallet. In 2013, the enduring scandal is that the quality and length of your life depend on your postcode. To remove the appalling inequities in health that we have allowed to persist and worsen will need action on many fronts.

The NHS cannot do it alone, but without a comprehensive health service, free at the point of use, we will never get there.

This is an extract from Jeremy Taylor’s contribution to the Nuffield Trust publication: The wisdom of the crowd: 65 views of the NHS at 65. The collection of essays was published on Thursday 4 July 2013.