Today marks the 75th anniversary of the founding of the NHS. It means 75 years ago today, in 1948, Britain’s first majority Labour government led by Clement Attlee created a national health service as the cornerstone of its plans for a comprehensive welfare state.
The National Health Service Act, which came into effect on 5 July 1948, brought together a wide range of medical services under one organisation, including hospitals, doctors, nurses, pharmacists, opticians and dentists. Led through its commons stages by the first minister of health Aneurin Bevan, the face of the Act read: “An Act to provide for the establishment of a comprehensive health service for England and Wales, and for purposes connected therewith”.
The first universal health system to be available to all, free at the point of delivery, was born.
Today, the NHS treats over a million people a day in England. It remains at the forefront of advances in medicine and four in five say it makes them most proud to be British.
But while the NHS remains much-loved, there will nonetheless be a sombre feeling as NHS staff in their uniforms fill into Westminster Abbey this morning.
The public remains deeply dissatisfied with the state of the health service; indeed, according to researchers at the King’s Fund, the public gave the NHS its worst rating since records began 40 years ago. In all, just 29 per cent said they were satisfied with the NHS in 2022, with waiting times and staff shortages the biggest concerns. That is seven points down on the year prior and a drop from the 2010-high of 70 per cent satisfaction.
Also undercutting today’s festivities is further research from the King’s Fund which exposes how Britain’s healthcare system has far worse outcomes than almost all of its peers. Comparing 19 major nations, the think tank found the NHS was second worst of all those examined for saving lives. The UK was found to be worst at saving stroke victims and second worst at saving heart attack sufferers, while “underperforming significantly” on cancer and life expectancy.
Still, a poll in May last year found the health service top of the list of things people thought were best about Britain. It means, despite alarm bells ringing on the state of the health service, the famous dictum attributed to Aneurin Bevan, that “The NHS will last as long as there are folk left with faith to fight for it”, holds firm.
The government’s workforce plan
Last week, the government announced a plan to tackle some of the NHS’ most gloomy indicators — beginning with the workforce. The NHS workforce plan, timed to coincide with commentary over the health service’s 75th birthday, sees ministers commit to independent verified forecasts for the number of doctors, nurses and other professionals needed to maintain the workforce over the next five to fifteen years. Commissioning Health Education England to review trends in the health and regulated social care workforce, health secretary Steve Barclay has now set aside £2.4 billion over five years for the plan. The prime minister insists the strategy has set out the “largest expansion in training and workforce in the NHS’s history”.
Moreover, the government argues it is on track to meet its target for 50,000 more nurses by the end of March 2024. This is despite warnings coming from the health and social care committee, led by Conservative MP Steve Brine, which suggest the demand for nurses is increasing much faster than supply. In September 2022, 133,450 vacancies were recorded across the NHS in England and of these 47,500 were for nurses.
Funding
The government also insists that the NHS has recently faced the most significant pressures in its 75-year history, including the Covid-19 pandemic, the worst winter pressures in a generation last year and, more recently, inflation and the cost-of-living crisis. Certainly, the trauma wrought by Covid on the NHS and its staff is still having a pernicious effect. The pandemic hit Britain’s health service at colossal expense and led to the disruption of systems and the cancellation of routine procedures.
But critics say the problems have been compounded by ministerial mismanagement.
David Cameron’s 2010 election campaign sported posters promising to “cut the deficit, not the NHS” — and a key aspect to how austerity was implemented for much of the 2010s was a focus on protecting funding for the day-to-day running costs of the NHS. However, for much of the decade, the protection of NHS services was only protection relative to the cuts other public services faced, not funding rising in line with historical growth in NHS spending or demand for services. Cameron decided to reduce the NHS’ annual budget increases from Labour’s 3.6% to an average of just 1.5%.
In testimony to the official Covid-19 inquiry, David Cameron defended the decisions made on NHS funding. “Your health system is only as strong as your economy — one pays for the other”, he said. But Jeremy Hunt, health secretary from 2012 to 2018 and chancellor today, told the British Medical Journal in 2021 that his decisions as health secretary had adversely affected the NHS’ capacity and hence the UK’s preparedness for the pandemic.
A 2022 paper from the King’s Fund, moreover, explained how a “decade of neglect” by successive Conservative administrations has weakened the NHS. “The sporadic injections of cash during the austerity years after 2010 were at best meant to cover [the service’s] day-to-day running costs. This dearth of long-term investment has led to a health and care system hamstrung by a lack of staff and equipment and crumbling buildings. These critical challenges have been obvious for years”, said the King’s Fund chief executive, Richard Murray, at the time.
The strikes
The cost-of-living crisis and rampant inflation have also prompted a round of strikes which intermittently bring the NHS to a standstill. The Royal College of Nursing began the present dispute after they announced their intention to ballot members for industrial action for the first time in their 106-year history on 6 October 2022. The first strike began on 15 December last year and the industrial action remains unresolved. Nurses have since been followed by Ambulance workers and junior doctors in walking out, and later this month, from 7 am on Thursday 13 July to 7 am on Tuesday 18 July, around 47,600 junior doctors represented by the British Medical Association will strike.
Medical professionals have consistently voted against the government’s offer of 5 per cent plus a non-consolidated payment in England. Junior doctors, for example, in England want a 35% pay rise to make up for what they estimate to be a 26% cut in their real terms income since 2008-09, plus inflation.
The latest polling carried out by Ipsos between January and June shows about two-thirds of the public support striking nurses, ambulance workers and junior doctors, despite the growing numbers of appointments and operations having to be cancelled. It compares to polling which showed that 48 per cent of the public said they supported teachers in their strikes in June. Likewise, only 36 per cent supported airline workers, railway workers and border force staff taking action, while 35 per cent supported university lecturers, 34 per cent civil servants and 28 per cent driving instructors.
The figures are arguably a testament to the special place the NHS occupies in the British public consciousness.
Looking to the future
Since 1948, the NHS has tended to evolve and adapt to meet the needs of each successive generation. Today, the NHS touts its record as a leader in adopting innovative medicines, with industry data showing there are five treatments available in England for every four in Europe, as well as almost a third more cancer drugs.
Embracing innovation and technology is increasingly said to be critical in enabling the NHS model to deliver better outcomes for our growing population. And last week, Amanda Pritchard, chief executive of NHS England, said further applications for artificial intelligence (AI) in the NHS are “on the horizon” in a bid to free up doctors’ time and provide better support to patients. Rishi Sunak has said the use of robot receptionists will be used to free up NHS staff under a 15-year workforce strategy to build a service “fit for the future”.
In a speech delivered at NHS ConfedExpo, shadow health secretary Wes Streeting called for technology to be upgraded to stop the health service “being held back by creaking, outdated technology”. He added that AI “can rule out cancer-free scans in seconds” and can “help interpret chest X-rays” to save radiologists time, but the technology had yet to be adopted or rolled out across the NHS.
Throughout its full 75-year history, the NHS has been under the stewardship of Conservative governments for 48 of them. But on current polling, Labour are on track to win the next election and the future of the NHS will hence be in the hands of Sir Keir Starmer and Streeting. The party continues to tout their plan to raise £1.6 billion a year from non-dom tax reliefs to spend on training and the NHS workforce.
But with one of the party’s “missions” committing Labour to “building an NHS fit for the future”, voters will be expecting Keir Starmer and Wes Streeting to set out further proposals in the lead-up to the next election.
