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Editor's Choice

The NHS at 70: many happy returns?

BMJ 2018; 361 doi: (Published 28 June 2018) Cite this as: BMJ 2018;361:k2809
  1. Sophie Cook, UK research editor
  1. The BMJ
  1. scook{at}

It is right to celebrate the NHS’s 70th anniversary. It is admired beyond the UK and has weathered many restructures, adapted to medical advances, and managed a growing population with longer life expectancy, all while coping with increasing financial strain. On 5 July we can light the candles, raise a glass, cut the cake, or otherwise mark this historic occasion.

While celebrating the achievements we can’t ignore the widening cracks. Despite its overall top performance in an influential international comparison last year, in terms of outcomes the NHS has fallen in global rankings.1 And we shouldn’t take for granted the public’s deeply rooted support. The terrible events in Gosport (doi:10.1136/bmj.k2706) may be anomalous and historical, but they add to the damage done to the NHS brand by previous scandals such as Mid Staffordshire. The patient safety campaigner James Titcombe says our goal must be for every organisation involved in healthcare to treat patients or families raising the alarm as “vital voices to be heard and not problems or issues to be managed” (doi:10.1136/bmj.k2783).

Relations between doctors and the NHS have evolved. Nick Timmins uses his 40 years’ experience as author and journalist covering the NHS to explore the decline of male dominated medicine, the rise of shared decision making, and the promise of technology (doi:10.1136/bmj.k2683). Viewed from the outside, he says, “medicine remains a hugely attractive and rewarding career.” There isn’t a decade of the past he would swap for the present.

All eyes are now on the government. More money is promised, but where will it come from and how will it be spent? Questions remain concerning funding for public health, education and training, and, perhaps most importantly, social care. “In the space of a week,” writes Chris Ham (doi:10.1136/bmj.k2741), “the tectonic plates of the NHS have shifted not only on funding but also on the means the government will use to improve care.” In the first of a new series of articles examining the NHS’s sustainability, Mark Hellowell and colleagues consider what funding models can best ensure a healthy and just society (doi:10.1136/bmj.k2566).

What then is the NHS’s greatest achievement? Providing care on the basis of need and free at the point of delivery was the winner in our online poll (doi:10.1136/bmj.k2770). This founding principle of the NHS stands as proudly today as it did 70 years ago. “Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune the cost of which should be shared by the community,” said Aneurin Bevan. By this standard the NHS has excelled, and it continues to lead the world in universal health coverage.

Perhaps the NHS’s greatest achievement though is its sheer survival. How can we ensure it survives another 70 years? The answer lies in political will, public support, and the dedication of health professionals who have worked to deliver a national health service true to its founding ideals.


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