This week the NHS celebrates its 60th birthday. It should be its most benign anniversary in recent memory. Satisfaction levels are high,1 and the British public now rates the economy, crime, and race relations as more important problems than the NHS (figure⇓).2 Increasing satisfaction with the NHS probably explains why the numbers of people buying private medical insurance have been falling since 2002.3 Last year the service made a surplus of at least £2bn (€2.5bn; $4bn) and is expected to make a further surplus this year.4 Productivity in hospitals is finally going up,5and the NHS is now the third most popular employer for UK graduates, after the BBC and Apple.6 Politically, it’s hard to detect any major difference between the policies of the Labour or Conservative parties towards the NHS, both of whom are falling over each other to be regarded as the natural custodians of the nation’s most cherished institution.

Yet many working in the NHS are fearful of the ultimate consequences of recent policy changes, which have been driven by values very different from those that underpinned the NHS for most of its 60 years. Workers worry that the days of the NHS as proxy state religion are numbered (box 1), and they don’t like the alternatives.