The NHS at 70: reasons to be cheerful and fearful

Abstract

This month’s 70th anniversary of the National Health Service isn’t surrounded by celebratory euphoria. Advances in population health and patient care are clear albeit mixed in comparison with similar economies. It’s also hard to disentangle how much of the improvement is because of the NHS and how much is down to factors outside the health sector such as technology. Nor is a service experiencing rising demand but hampered by understaffing able to take much solace from the government’s recent announcement of an increase in funding.

Debate will continue over whether a £20bn funding boost spread across the next five years is enough and how it will be raised. But, for a moment, let’s turn our minds from funding crises and consider positives. Admirably, to most if not to all, the NHS remains free at the point of delivery. That’s something to celebrate. The service provided is based on need, and not wealth, although we know that needs cannot always be matched by the care that is offered. That’s called rationing, and rationing is a ground reality for all health systems.

Second, the NHS is the world’s most prominent case study in universal health coverage, which is currently the dominant idea in global health. The sustainable development goals, adopted by all member states of the United Nations, include universal health coverage as a central pillar. Universal health coverage is the loudest rallying cry of Tedros Adhanom, the first African to lead the World Health Organization. Whether critics like it or not, universal health coverage is the idea that has won out in terms of how health systems must make people healthier. We know that there is much to fix with the NHS but its underlying philosophy of universal health coverage is as relevant today as it was 70 years ago.

The NHS can’t stand still, though. Indeed, it rarely does. Many professionals believe the NHS has moved too fast and too illogically with endless restructuring and ‘redisorganisation’. But without evolution and sustainability, the NHS will be lost. Some of the currents of an improved NHS are highlighted in this issue. The workforce will change, as will the role of health professionals.¹ Carers will be more prominent, better understood and better acknowledged.² Empathy skills will help professionals work better with patients.^3,4

These are reasons to be cheerful but we will require such evolutionary changes and more. Even if we choose to stand still in our thinking and practice, we know that nature and the threats to humanity will not. They are tirelessly adapting and marching to eliminate the human infestation of planet Earth.⁵

References

Jewell

Majeed

. The F3 year: what is it and what are its implications? J R Soc Med 2018; 111: 237–239.

Greenwood

McKevitt

Milne

. Time to rebalance and reconsider: are we pathologising informal, family carers? J R Soc Med 2018; 111: 253–254.

Howick

Bizzari

Dambha-Miller

. Therapeutic empathy: what it is and what it isn’t. J R Soc Med 2018; 111: 233–236.

Howick

Moscrop

Mebius

Fanshawe

Lewith

Bishop

et al.

Effects of empathic and positive communication in healthcare consultations: a systematic review and meta-analysis. J R Soc Med 2018; 111: 240–252.

Morabia

. Edward Jenner’s 1798 report of challenge experiments demonstrating the protective effects of cowpox against smallpox. J R Soc Med 2018; 111: 255–258.