The NHS at 75: can it make it to 100?

The National Health Service celebrates its 75th birthday today – but as it reaches its landmark anniversary it faces an uncertain future.

Founded in 1948 under Clement Attlee’s Labour government, the NHS was the first universal health system in the world to be available to all and free at the point of delivery.

But an ageing population, staff shortages and huge waiting-list backlogs – to name just a few of its seemingly intractable problems – have left many wondering whether the healthcare system will survive to its centenary.

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What challenges is the NHS facing?

There is little doubt that the NHS is “profoundly cherished” in the United Kingdom for the “still astonishing cradle-to-grave” principle of care that underpins it, but there is “no question” that it is “very sick”, said Esther Addley in The Guardian’s First Edition newsletter.

There has been a spike in the number of people dying as they wait for ambulances, waiting times for treatments have “almost tripled” since 2020, while GP surgeries and mental health services are “at breaking point”. Meanwhile, staff are “leaving in droves”, and junior doctors, nurses – and most shockingly – even consultants are going on strike over pay and patient safety concerns.

One of the main challenges facing the NHS is the shift from providing short-term care – its “main focus” when it was created – to providing long-term care for the chronic health problems found in an ageing population, said the BBC. People aged over 65 will have at least two chronic conditions. It is estimated that about £7 out of every £10 spent in the NHS goes on people with these conditions. And as the UK’s population continues to age, “the situation is only going to worsen”.

The amount of public money spent on the NHS has steadily increased since it began. More than 40p out of every £1 spent on day-to-day public services is now spent on the health service, leaving many wondering “whether such spending is sustainable”.

How does it compare to other countries?

While the UK was not the only country that needed to “catch up with routine care after the pandemic”, other countries have fared much better with that task, said The Times. A recent King’s Fund report compared the NHS with 18 other international health systems, and found that countries such as Germany and Singapore are now able to “speak about their backlogs in the past tense” as – unlike the UK – they had spare capacity within their healthcare systems they could use to catch up.

The report gave the NHS a mixed bill of health, with the UK doing “better than comparable countries in some areas, and worse in others”, adding that there was “little evidence that one individual country or model of healthcare system performs better than another across the board”. It suggested that reforming a country’s existing model of healthcare, rather than adopting entirely new alternatives, appeared to be the most effective way at improving the health of a nation.

But in some areas, the NHS is doing particularly badly. For example, the UK has fewer doctors and fewer nurses per 1,000 people than the average. According to the report, “while some countries do, for example, have fewer nurses, many counterbalance that by having more doctors”. But the UK “is remarkable as it scores low on both”. The UK also has the fewest CT scanners and MRI machines of any comparative country.

How can these problems be solved?

In a policy paper, former Labour leader Tony Blair has argued that making much more use of private healthcare providers is key to cutting waiting times, including embracing “co-payment options” which would allow patients to pay for faster treatment, or to “co-pay” towards services that the NHS would not otherwise fund.

Three of the UK’s leading healthcare think tanks have written to the leaders of the country’s three main political parties warning that the NHS is unlikely to reach its centenary if they persist with short-term policy decisions and promises of “unachievable, unrealistically fast improvements”.

In a joint letter, the Chief Executives of the Health Foundation, Nuffield Trust, and The King’s Fund have emphasised the need for long-term plans, investment in physical resources, reform of adult social care, improvement of social and economic conditions, and sustained commitment to the government’s recently published NHS long-term workforce plan.

Can the NHS survive in its current form?

Support for the NHS is still very strong, said The Guardian. And while the lack of healthcare before the NHS is “still a part of living memory”, support for the service is not strong simply because “people dread a return to the 1930s, but because they can see the alternatives that exist right now”. Few want their health “placed in the hands of profit-seeking businesses”, argued the paper.

The NHS has little to celebrate, said The Telegraph, with millions of people on waiting lists, overcrowded A&E departments and a “broken” primary care system. “How can this be considered a success story by any measure, let alone ‘the envy of the world’?”. In order to hold on to the NHS’s founding doctrine – that healthcare should be universally accessible and free at the point of delivery – we appear “prepared as a nation to put up with poor care, provided it is easily accessible”. It is an “egalitarian fetish that is literally costing people their lives”.

The creation of the NHS is a “cause for celebration” said The Times in its leader today. “Free healthcare for those who cannot afford to pay for treatment is the bedrock of a civilised society,” continued the paper. But if the NHS is to reach its 100th birthday in “good health” it requires “less worship, less politics and more unsentimental inquiry into what works”.