Is an independent NHS an impossible dream?

When the NHS was founded 75 years ago would anybody have guessed, in the unlikely event that they asked the question, that this month’s JRSM would feature articles on carbon footprints, ¹ genetic testing after death, ² and artificial intelligence? ³ That these issues seem entirely routine to us underline the difficulty of predicting the future.

With the NHS in a crisis and in need of reform or resuscitation – depending on how you view the world – soothsayers and futurologists are in business predicting the trajectory of a health service struggling to cope with increasing demand and a rapidly changing world. As hard as predicting the future is, it is an exercise of merit, and it requires a deep understanding of the past to learn from successes and failures. The merit is in helping us navigate a way ahead. In a state of high unpredictability, looking for unifying themes in a variety of scenarios is an approach worth considering.

One persistent paradox of the NHS is that its policy direction is tightly tied to short political cycles when a health service requires a political consensus that takes a more enduring view in order to best serve the needs of the population. In any scenario, it is imperative to understand how best to weigh up benefits and harms, ⁴ but the logic of a political consensus is that the health service is to a greater degree independent, or at least at arms length, of politicians.

Understandably, this is a situation that politicians find untenable. The electoral benefits and harms of the health service appear too acute. Yet that is somehow the leap our politicians must make, to act in the best interests of the population’s health and wellbeing. One way to do this might be to move to a health and wellbeing economy as now advocated by the World Health Organization. ⁵

I recently asked a former chair of the NHS whether it was possible to organise the NHS to be independent of politicians. The answer was an emphatic ‘no’. He’d thought of it, debated it, but it was a non-starter. This was a fair and reasoned judgement, however, what seems impossible today may be possible tomorrow. Who would have imagined our future would so soon be threatened by artificial intelligence — not even Isaac Asimov.

The NHS is 75 years old. It was founded on ideals. Is it so implausible to be idealistic again? Is it so dangerous to harbour human and electric dreams of an independent NHS for the benefit of people and the planet instead of for the electoral fortunes of politicians? Those same politicians might even find that keeping the NHS at arm’s length buffers them from electoral turbulence. Where would we be without idealism, without dreaming a dream? Would we even be talking of the NHS at 75?