Intended for healthcare professionals

Opinion Talking Point

John Launer: A generation betrayed

BMJ 2023; 381 doi: (Published 26 April 2023) Cite this as: BMJ 2023;381:p901
  1. John Launer, GP educator and writer
  1. London
  1. johnlauner{at}
    Follow John on Twitter @johnlauner

As you can see from my photo in the print edition, I’m the oldest columnist in The BMJ. I’m past retirement age, although I’m still employed by the NHS for part of the week. I’m certainly old enough (and have enough medical conditions) to be thinking about ageing, decline, frailty, and from time to time even death.

I’ve never had the illusion that any of these things would be easy. I’ve accompanied too many people—friends, relatives, and patients—on the gruelling journey from health to headstone. I’ve tried not to kid myself that my route would be any more pleasant than most of theirs. But at least I’ve had one consolation: that the NHS would be there for me each step of the way.

We grew up together, the NHS and me. My GP when I was a child worked on his own, from one room in his house. He seemed perpetually overburdened. When I became a GP myself in my 30s, I joined a practice that had four doctors, two health visitors, a midwife, a practice nurse, and a team of district nurses. Our lives were much easier than that of my childhood GP: the range of services we offered were beyond anything he could have imagined, and they continued to expand for the next 20 years and more. During the same period, the hospital I attended for bad eczema in my early years—a dilapidated place in Soho’s red light district—had been relocated to a newly built teaching hospital, with facilities to match any in the world.

I don’t want to romanticise those years of plenty. On both sides of the desk, as professionals or patients, we still complained. We believed that we could do with more services, more resources, more money. We thought that no government was generous enough to make things as good as they ought to be. But here’s the thing: we always believed that the health service would continue to improve.

Since 2010, that belief has been destroyed. From being more highly regarded in that year than at any other point in its history, the NHS has sunk to being a cause for international shame. I’m reminded of a famous line from W H Auden: “I thought that love would last forever. I was wrong.”

The BMJ is full of accounts of how bad things are in the NHS. I don’t need to add to the list. But, as an older person, I want to state that I’m now afraid. I’m scared of dying in pain, dehydrated and unattended, on a trolley in a hospital corridor. I’m frightened that I’ll end my days on a ward where the staff, however hard they try, won’t have the time or resources to give me the care I need, either to cure me or to relieve my passing.

It’s a feeling I share with millions of people my age and older who never imagined that this could happen. We lived our lives with the hope of a better NHS, a better old age, and better deaths. That hope has been betrayed.


  • Competing interests: None declared.

  • Provenance and peer review: Commissioned; not externally peer reviewed.