It is our governments’ duty to protect health

Dear Editor

I agree with Dr Arnold's response (ref 1) in which he reminded all that healthcare is but only one (albeit an important one) basic service, and that healthcare has "to compete for funding with all other 'expectations'" a democratically elected government have to consider.

As I have previously written (ref 2), Bevan's plans were based in part due to William Beveridge's flawed idea that the National Health Service would justify itself as a good investiment and that, as a result of the improved health and productivity of people, the cost of the health service would progressively fall and even be offset by economic gains (ie the country would get the National Health Service for nothing).

Enoch Powell in 1961 described this assumption by the economist in his 1942 report (Beveridge Report, officially entitled Social Insurance and Allied Services (Cmd. 6404)) as a 'miscalculation of sublime dimensions'.

As reflected by Michael Portillo (ref 3), Bevan convinced Attlee to make party political capital out of the introduction of the NHS, and the "Labour party has had a permanent advantage over the Conservatives ever since".

He further wrote:
"So Bevan was politically shrewd. But the politicisation of the NHS has been greatly to the harm of the service itself. Rational debate has become very difficult. Every sort of change, including the replacement of old hospitals by new ones, has been presented as an attack on the service. It has made the Tories timid about reform—and it has made the Labour party cling to the Bevanite dogma of a health service financed only from taxes." (ref 3)

And that was back in 1998; I doubt anything has changed since.

In the book "From cradle to grave: fifty years of the NHS" by Geoffrey Rivett and published by the King's fund in 1998, marking the 50th anniversary of the NHS, the author concluded:
"Striking a balance between cost, quality, equity and timeliness of care is an international problem. It is arguable whether the present system in this country can contain the pressures for increased expenditure much longer. On the other hand, it is not obvious that any other country has a better answer. Clinical advance will continue to create costly opportunities to extend life or improve health, it is possible that we will be able to maintain our tradition vision of the NHS, trimming here and advancing there. The NHS might continue to muddle along, as Lord Horder said in 1939, making an apparently unworkable system work, the honourable partnership between the professions and the state, for which Lauriston Shaw argued in 1918, might ultimately be established. The alternatives are few and not politically easy to accept. Yet we may have to face the unpleasant possibility that, in the second 50 years of the NHS, the ever-growing opportunities and costs will make it impossible for health services to maintain themselves outside the laws of cost, supply and demand that influence distribution of services and products elsewhere in our society, One would wish to maintain a system of which its founders would approve. However, the costs and opportunities are continually growing. We have to face the unpleasant possibility that it might be impossible to maintain a comprehensive NHS. There lies our dilemma. "

How prophetic of the times since, and yet the issues raised remain so current.

References:
1. https://www.bmj.com/content/374/bmj.n2334/rr
2. https://www.bmj.com/content/366/bmj.l5645/rr-3
3. https://www.bmj.com/content/317/7150/37
4. https://archive.kingsfund.org.uk/concern/parent/000018818/file_sets/9c54...