Intended for healthcare professionals

Observations Now and Then

Is the NHS three times better than in 1979?

BMJ 2010; 340 doi: (Published 31 March 2010) Cite this as: BMJ 2010;340:c1769
  1. Richard Smith, director, UnitedHealth Chronic Disease Initiative
  1. richardswsmith{at}

    The tripling of NHS spending in 30 years, even in today’s prices, has increased unhealthy lifespans

    Reading recent accounts in the BMJ of how various doctors and managers would make savings in the NHS, I thought back to a series on the same idea that I edited when I first arrived at the BMJ in 1979, called “If I was forced to cut.” What I thought was the cost of the NHS then was about £35bn (€39bn; $52bn) in today’s prices, whereas now it’s well over £100bn. What have we got for that near tripling in spend in less than a professional lifetime? Has it been worth it?

    My suspicion is that any doctor practising in 1979 will immediately answer “no” to that last question. Things weren’t so bad then. Indeed, for many doctors they were much better. Patients were grateful. There was much less bureaucratic hassle. This was long before Bristol and Shipman, and doctors were still seen as part of the solution rather than part of the problem. There was camaraderie, black humour, lots of …

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