Intended for healthcare professionals


Healthcare for everyone: the trials and tribulations of the NHS model

BMJ 2019; 366 doi: (Published 26 September 2019) Cite this as: BMJ 2019;366:l5645
  1. Nicholas Timmins, senior fellow
  1. King’s Fund, London
  1. n.timmins{at}

The NHS has been striving to provide healthcare for all since 1948. This approach has had its ups, downs, and limitations. But Nicholas Timmins finds that it looks pretty stable—at least in the short run

Over the decades, British health ministers have tended to claim—although recently, thankfully, rather less frequently—that the UK’s National Health Service is “the envy of the world.” Whether or not it ever was, and that’s highly debatable, one aspect has always attracted international interest.

It provides universal healthcare. Furthermore, it’s deeply loved by the British people—at times almost irrationally, in the face of mounting international evidence that it’s good at some things but appreciably less so at others.1 When people are asked what makes them proud to be British, the NHS is always at or near the top.

A core reason is that, ever since its foundation in 1948, it’s been available to all. No one in the UK goes bankrupt from medical bills. Brits remain deeply attached to the NHS’s tax funded, largely free-at-the-point-of-use nature. In a country where the gap between rich and poor has long been widening, and where the vote to leave the European Union has created new divides and amplified old ones, the NHS is one of the few remaining emblems of being “all in this together.”

Sharp readers will already have noticed some qualifiers, not least “largely free” at the point of use. Right from the start there were a few charges—for wigs for medically induced baldness, for example. Within a few years the first charges for dental treatment and prescriptions crept in. In the succeeding decades, chiefly the 1980s, bits fell off the edges. Mainly teeth and specs.

The funding of spectacles and some sight tests is now largely private. And there are significant charges for NHS dentistry—where …

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