Where did the NHS come from and where is it going?


Where did the National Health Service come from and where is it going? The first part of that question is easy, though some of you may be surprised by the answer. The NHS was born of ideas in A. J. Cronin’s book, The Citadel. In October 1942 an idealistic, newly qualified doctor arrived from Scotland to work in a mining town in South Wales. Later, he moved on to work as an assistant in the miners’ medical aid scheme. The experiences and the travails of this young man and the conflict he experienced, practicing medicine for the working classes and wealthy private practice, are the bones of the book. It’s a great read.

Cronin was a doctor. He worked for the Tredegar Medical Aid Society, which went on to be the inspiration for the NHS. The rest, as they say, is history. A history of political courage, vision and determination.

Where is the NHS going? The easy answer is: it’s going where we want it to go. A tougher answer: it’s going where it needs to go. Maybe the future is a mix of the two. There is an intimacy about the NHS, a warmth. At its very best the NHS reaches into our lives; it is blind to our accidents and the stupidity which causes them. It looks the other way when the temptations of life overcome us with addiction and lifestyles we wish we didn’t have.

The NHS overlooks our failings and foibles and gives us compassion and understanding when life and happenstance takes us where we don’t want to be. Questions over its sustainability are only asked because it has had eight years of, pretty much, flatline funding. Trusts are doing more work than they are paid to do and, as a consequence, have plunged into debt.

Funded properly, of course the NHS is sustainable. If it had had eight years of average uplift, year on year, would we be having this conversation? Staff, who measure their work in sweat and missed breaks, go home exhausted and come and do it all again the next day make it sustainable. The NHS runs on the vapours of money and the fuel of vocation.

Will the NHS change? It has to. Not because it is stupid, but because like every healthcare system in the world, it is confounded by ageing populations, dementia, diabetes, obesity and all the other ailments of developed nations. No health system has enough staff. By 2035, there will be a global shortage of seven million.

Consultations on the phone or Skype, the use of data to determine the path to efficiency and better treatments. The science fiction of genomics will become the reality of the care for our kids and our kids’ kids.

We know what to do and how to do it. The NHS is capable and willing to take on the challenge of the next 70 years. But it will need some help. The NHS is there for us because it looks like us, looks after us, behaves as we behave and is only good enough if it is good enough for our families and our loved ones.

The NHS is the finest example of politics delivering for the people that I can think of. It has come to mean so much in our lives. Our culture is fragmented, politics ugly, technology scares us all to death, the economy is on the brink and the future uncertain at best – the one thing we can all depend on, rich or poor, deserving or not, is the NHS. We have Labour to thank for that.

Roy Lilley is a health policy analyst.

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