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When the NHS was formed in 1948, it was one of the greatest social achievements of any nation in the history of humanity. Setting up a healthcare system, for all citizens, free at the point of delivery was superb. The fact it was set up under an overarching set of Guiding Principles also illustrated the morality and aspiration of the scheme.
Britain in 1948 was a very different place to today. The country was nearly bankrupt following the war, the Empire was dissolving and malnutrition and life threatening sickness were rife. Average life expectancy for men was 66, the greatest issues were pneumonia, meningitis, polio and child mortality. This was the first time in the world that such a system has been set up.
fast forward nearly 70 years and things are very different;
Life expectancy is well over 70 now, and there has been a massive increase in palliative and complex treatments. These are much more expensive and time consuming than 'simply' curing the previous diseases which people suffered from.
our ageing population means we have already passed the mathematical point in time when working people (who pay tax to fund the system) have been outnumbered by non-working or retired people who no longer pay anything in. It is not relevant to say that they have already paid in for their working lifetimes because the system is not a 'bankable' one. In other words, money goes in every year and money goes out every year .... people do not build a fund of monies for treatment
It is a public point of grievance that non U.K. Citizens, foreigners and refugees etc are able to access the system equally despite having never paid anything towards it. Nobody really knows how many of these do so.
This means that it is essentially impossible to adequately budget for the services, nobody really knows how much next year will cost, nor where the pinch points will be in the service.
it is a fact that the Service has moved away from simply treating life threatening illnesses, which is what it was intended to do, towards palliative and lifestyle issues; dementia, Alzheimer's, smoking and alcohol related issues, obesity etc. It was not meant for that. Even today, the NHS is superb at dealing with emergencies, but not so good at non-emergencies.
Worst of all, the NHS has become a political football. The public and media 'love' the NHS, it is 'the best health service in the world', the 'envy of other countries', it is 'precious', everybody who works in the NHS is a 'hard working angel'. The media and politicians always trumpet they will 'save the NHS', or its 'in crisis' at an existential humanitarian level.
having personally worked on the fringes of the service for 20 years, and my wife has worked within it for 25, I can confidently say that therefore as many lazy good for nothing tossers working there as in any other big organisation. The leadership is sorely lacking, and the system is institutionally set up to resist change and innovation. Being run by the government really is a fate worth than death too.
Final salary pensions are pretty extinct now, because of black and white maths and also various government robberies of funds. Longevity and an imbalance in age demographics means they are financially simply unsustainable. Surely the same logic remorselessly applies to the NHS too?
Currently, we have a system that was fit for purpose in 1948. Now it's badly led, it's doing things it wasn't intended to do, it is simply too big and cumbersome to manage properly, it is very inefficient .... but it has become a 'holy grail' in the minds of the media, politicians and the public.
where to go?
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Re: The Myth of the British National Health Servi
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