Helen Salisbury: The NHS at 75—a sign of a civilised society

Nye Bevan, founder of the NHS, once wrote, “No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”1 This statement, which is at the heart of our health service, still commands support from the vast majority of the UK population.2

It’s frightening to be ill. A serious diagnosis, or symptoms we think may be the precursor to one, can turn our world upside down. The plans we had for new projects or retirement are overturned, any certainty about the future suddenly gone. In Bevan’s civilised society, although we can’t negate that fear, we’re assured that the best available treatment will be given, regardless of our ability to pay. In less civilised societies there’s a justified fear that treatment costs will leave people bankrupt and rob families of their security. In the US more than half a million people file for bankruptcy each year because of medical bills.3 In the UK we can be confident that, whatever investigations or treatments are required, we won’t be forced to dig into our own pockets or make difficult choices between healthcare and other needs.

However, the timeliness of that medical aid is now in question. Cancer care deadlines are increasingly missed.4 Patients with treatable problems that prevent them from working are often left waiting many months and may sink into debt while they wait. If you need a joint replacement you may be one of the lucky few who can easily afford to be treated privately, or you may be willing and able to sacrifice your life savings to this end. But the majority have no such choices and must join a lengthy queue.

On its 65th birthday, the NHS was itself in good health. It’s true that some of its early promise had not been realised, and there were worrying developments in the shape of the Health and Social Care Act 2012—but, overall, most patients were getting the care they needed, when they needed it. Fast forward 10 years and the service is looking much less robust, the equity envisaged by its founders far less assured. Its buildings are crumbling, staff are leaving, and waiting lists are growing. This decline was not inevitable but is the result of bad policy decisions taken for ideological (or possibly self-interested) reasons. Some see the results as a deliberate choice, intended to wreck the NHS so that an alternative, profit generating service can rise up to take its place.5

The silver lining is this: if the decline is the result of a deliberate choice not to invest in people, equipment, and buildings, then we can make an equally deliberate choice to mend the NHS and turn it around. Here’s hoping that its next big birthday finds it in much better health, so that we truly have something to celebrate.