The NHS at 75: love, and political consensus, is all you need
BMJ 2023; 381 doi: https://doi.org/10.1136/bmj.p1479 (Published 29 June 2023) Cite this as: BMJ 2023;381:p1479
The NHS is 75 years old. It is damaged, demoralised, and distracted. It is also loved. By some accounts, love is all you need. And if love weren’t enough, the magic dust of the founding principles sprinkle the NHS with the aura of a religion too. To meet the needs of everyone, to be free at the point of delivery, and to be based on clinical need, not ability to pay, are principles that have endured—although some interested parties are eager to erode them. Love and religion make the headiest cocktail.
Loud echoes of those principles are heard in international calls for universal health coverage and health for all, global ambitions that the UK’s population has benefitted from for 75 years thanks to its beaten, bruised, but defiant health service. The formation of the NHS in 1948 was just in time for a nation in a postwar health crisis, but it was also ahead of its time.
The public’s emotional attachment to the NHS remains strong despite worsening health indicators over the past decade. But anybody who has loved knows that love isn’t perfect. Today’s NHS has made giant strides since its inauguration but may also be as imperfect as it has ever been. The calculus of demand and capacity is awry. A retention crisis in the workforce may lead to a mass exodus on the basis of pay, working conditions, and pensions (doi:10.1136/bmj.p1454, doi:10.1136/bmj.p1450).12 Staff are reporting more and more abuse (doi:10.1136/bmj.p1441).3 Instead of feeling like celebrating (doi:10.1136/bmj.p1460),4 early career doctors are readying themselves for an unprecedented five days of industrial action (doi:10.1136/bmj.p1448).5
The reasons for the decline in the population’s health and today’s NHS crisis are complex, but the short version is simple enough: it is political failure. The UK’s ongoing covid inquiry is a horrific catalogue of disastrous political decision making (doi:10.1136/bmj.p1443),6 not only applicable to the UK’s response to covid-19.
There are good political reasons why a new King’s Fund analysis finds that the UK is performing poorly by international comparisons (doi:10.1136/bmj.p1451).7 Austerity, unapologetically and unempathetically delivered by David Cameron and George Osborne. Jeremy Hunt's misjudgments, acknowledged by his own retrospective hollow remorse. Matt Hancock. The old school economic vacuum that Rishi Sunak inhabits. And the lies of Boris Johnson that led to the deadly distraction of Brexit. These are verdicts deserving of a political consensus, if the job of politics is to put people first.
The question is how do we get out of this? The answers are even more complex, but they begin with hope, a vision of something better, a sense of the key challenges that must be tackled from here on out, including the elephant in the room of climate disaster (doi:10.1136/bmj-2022-072328), doi:10.1136/bmj.p1331).89The BMJ’s Commission on the Future of the NHS will help lead that thinking, and some of our commissioners spell out their personal aspirations in a feature this week (doi:10.1136/bmj.p1422).10 They promise values, principles, and evidence based and people centred strategies.
Solutions do exist, but they are a combination of short term fixes and long term strategies and investments (doi:10.1136/bmj.p1458).11 These ideas and innovations, these hopes and dreams of millions, will come to nought unless there is long term political consensus about a vision and strategy for the NHS. Such consensus will be hard to achieve, but it must be delivered and adhered to.
Politicians have brought the NHS to its knees in time for its 75th anniversary. Their duty to the public is to raise this flawed and beloved giant once more to its greatest height. Love isn’t all the giant needs. It also needs urgent care (doi:10.1136/bmj.p1452),12 leadership (doi:10.1136/bmj.p1446),13 equity (doi:10.1136/bmj-2022-073445),14 rehumanising (doi:10.1136/bmj.p1447),15 and a silver lining (doi:10.1136/bmj.p1459),16 to name a few. But political love, or even some grudging appreciation, would be a good place to start.