The rhetoric and the reality of the UK’s National Health Service have rarely been further apart. On Wednesday the health secretary, Steve Barclay, will read prayers at a celebratory service at Westminster Abbey, while NHS England’s chief executive, Amanda Pritchard, will join a procession. Given the NHS’s status as a beloved national institution – the closest thing the English have to a religion, Nigel Lawson famously claimed – it is not unexpected that its 75th birthday should be marked this way. But it is jarring to see the state staging such a spectacle while the health and care system increasingly feels broken to staff and patients in clinics, hospitals and therapy rooms around the country.
It didn’t, and doesn’t, have to be this way. Polling carried out for the Health Foundation shows that 72% of the public believe the NHS is crucial to British society and should remain free at the point of use, while 80% think it needs increased funding. At the same time, 71% expect new charges to be introduced over the next 10 years. This combination of loyalty and pessimism indicates how seriously successive Conservative governments have let the public down. Their systematic underfunding of health, above all when David Cameron was prime minister and budgets were frozen, has led to the NHS struggling more and more to meet people’s needs. The failure to resolve longstanding issues in the social care sector, and refusal to regulate industries that profit by worsening public health, compound the problem.
We can still take pride in the NHS. On a given day, in England alone, there are 1.6m interactions between staff and patients. Last year there were 329m primary-care appointments with nurses or GPs. Excellent care is provided all the time, although not uniformly. But with 7.4 million people on the waiting list (and 1.6 million more across Northern Ireland, Scotland and Wales), and 112,000 vacant posts, even the rosiest spectacles cannot disguise the scale of the current crisis. Having struggled through the pandemic, urged on by the public’s applause, staff are burned out. The proposal this week from a group of backbench Conservative MPs to reduce the number of visas available to health and care workers added insult to injury. These roles should be better remunerated; given that they are not, British people are immensely fortunate that workers are willing to come here to look after us in a cost of living crisis.
Doctors’ strikes this month will cause disruption, but the public recognise them as a distress signal and a majority support them. The workforce plan announced last week is years overdue, and the £2.4bn attached to it cannot make up for years of cuts. This year’s 1.2% increase in NHS England’s budget is less than a third of the roughly 4% annually that is widely accepted as necessary to keep pace with demographic and technological changes in countries like ours.
Healthcare – or the lack of it – before the NHS’s creation is still a part of living memory. Yet support for the service is solid not because people dread a return to the 1930s, but because they can see the alternatives that exist right now. In particular, they do not want their health placed in the hands of profit-seeking businesses. This doesn’t mean that nothing should change. There is a role for further devolution, and relationships with local government must be strengthened. More attention and money should be directed to prevention, with the NHS seen not in isolation but as part of a system. Evidence suggests that the public recognise the need for long-term planning and investment. Pride and relief that the NHS exists mingle with bitter disappointment at the way it has been treated.
