The ideal remains strong, but the practice too has to measure up

“I believe with perfect faith in the NHS, in its ability to provide all health care for all people free at the point of use, in its ability to be equitable, fair, and compassionate, in its capacity to be efficient and effective, and, above all, in its capacity to give patients and users choices about the sorts of services they should receive.”

The NHS is like a theological institution. Its adherents, most of the population of the United Kingdom, believe in it passionately. Politicians who itch to reform it find themselves hopelessly out of sympathy with public opinion. Like the BBC, the NHS is an institution that binds the people of the UK together. It is seen to be fair, there when you need it, and the best in the world if you are seriously ill. No matter that the evidence is not necessarily there Like theological belief, belief in the NHS rests on assertions, apparently revealed truths—and woe betide those who try to say otherwise.

In part, that is because the NHS was set up with a moral purpose. It was new, exciting, encapsulating social progress, a guarantee of safety after the war, and a form of social contract. Fifty one years on, it is apparently much the same in the public mind: “[The NHS] symbolises the right of every human being to the dignity of health care based on need not wealth. It is the tangible experience of what I mean by community, working together—and paying taxes together—to create …