Intended for healthcare professionals

Feature NHS at 70

Back to the future: aspects of the NHS that should never change—an essay by Iona Heath

BMJ 2018; 362 doi: (Published 25 July 2018) Cite this as: BMJ 2018;362:k3187
  1. Iona Heath
  1. London, UK
  1. iiona.heath22{at}

Many changes to the NHS in its first 70 years have been for the better. But not all change is good, writes Iona Heath, pointing out the aspects of the health service that should be preserved

Social solidarity

The NHS was founded on the principle that comprehensive healthcare should be freely available to all, prioritised on the basis of need rather than the ability to pay, and funded through taxation.1 In the immediate post-war context of severe financial constraint and ruined towns and cities, the NHS represented a remarkable commitment to William Beveridge’s insistence that “the purpose of victory is to live into a better world than the old one.”2

These founding commitments established one of the few social institutions in the UK which gives its citizens a sense of a moral foundation to our society that they recognise, take pride in, and wish to protect. WH Auden wrote that the role of art was to teach people to love not to hate.3 For the people of the UK, the NHS has seemed to fulfil a similar role.

It is not surprising that these foundations are being shaken by the predations of late capitalism, with its insistence on the pre-eminence of the market as the driving force of every aspect of society. Yet, despite the NHS’s recent travails and the ideologically driven withdrawal of adequate resources, a large majority of patients, citizens, and professionals remain committed to the sense of justice and inclusion expressed by the existence of the NHS and a clear majority are willing to pay more tax to fund it.4

The aspiration is that each person using the service is valued for their own sake and that their moral stature is acknowledged and respected. This is not always achieved in practice but these failures …

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