The NHS at 80? How it might look in 2028

As the NHS approaches a key anniversary it is important to take stock and look back, not only on its first 70 years but particularly on the 10 since then—the period in which it has thankfully moved from dire peril to rude health.

What was the turning point as the NHS headed into its eighth decade? Everything came to a head, of course, in 2019, after the NHS signally failed to cope with the big increase in demand of every sort, prompted by the most severe flu outbreak for years, combined with a very long, harsh winter. The cross party inquiry into those failures pinpointed the clear increase in mortality, disability, and suffering, plus a doubling of waiting times by summer 2019 as most hospitals became emergency-only for several months.

This was despite what the inquiry described as an “outstanding flat-out performance in all the circumstances.” It concluded that the NHS could never cope with real demand while it was forced to plan and provide for a mythical, unrealistically low demand. It proposed radical change and the funding to enable it to happen.

The NHS could never cope with real demand while it was forced to plan and provide for a mythical, unrealistically low demand

That was when the force of public opinion kicked in. In the two comparable crises in the NHS’s history—in the 1980s, when the country (and the NHS) was financially on its knees, and at the turn of the century, when many people, particularly in their 20s and 30s, considered the NHS to be an outdated institution—public opinion had been divided about the case for support. By 2020, in contrast, the NHS’s place as the nation’s most treasured institution was secure. The public was united and vocal in calling for the inquiry’s findings to be implemented. And, surprisingly, the support of millennials and Generation X proved to be at the heart of this. Their growing realisation that they risked not only losing the housing and pensions their parents had known but also, at least as importantly, comprehensive free healthcare when they needed it, made this a political must.

It was not surprising, then, that in the remarkable general election that followed in 2021, all parties committed themselves to funding and supporting the NHS fully. That may have been one reason why the election was tied and may explain the extraordinary moment when the UK went German, with its first grand coalition government. Amazingly, the thing they found easiest to agree on, and which will be their lasting monument, was their rescue of the NHS.

The NHS coped with the winter of 2021-22, and year by year it has seen its crises fall away, progressively, to zero

The now iconic NHS Renewal Programme was started within three months. Its “immediacy” workstream tackled the most obvious and the worst shortfalls, failings, delays, and under-provision, using every permanent and short term fix in the book. Its effects were dramatic. The NHS coped with the winter of 2021-22—another bad one—with a fraction of the failings and horror stories of previous years, and year by year it has seen its crises fall away, progressively, to zero.

The parallel “Getting It Right for Good” workstream made a range of investments that took longer to bear fruit: some within a year or two, some only now, in 2028. The cumulative impact, however, has been there for all to see, as waits have tumbled, safety has improved, mortality rates have fallen, and patient satisfaction has risen.

The NHS got more funding—more importantly, funding based on the services it was having to provide rather than on what the government had arbitrarily chosen as the limit of what it would pay for, through its old cash limit approach. The country had agreed that it would support a dedicated health and social care tax, and it did.

For the first three years this tax rose annually (though by less than originally feared), but then a remarkable thing happened. As demand was fully met and provision was used more fully, optimally, and efficiently, without a profit being taken, some provision became surplus and was duly removed. As we now know, the tax went down, before the UK’s GDP health expenditure had even reached the OECD average. It is now virtually static and is likely to remain so, as real demand continues to be met.

No wonder the NHS is once again awash with visitors from around the world, wondering how we have achieved what they could only dream of.