IT’S all gone a bit 2020 this week.
Fortunately not in the sense that we are all stuck inside making baffling amounts of banana bread, but because it’s time to start clapping the NHS again.
Today marks the 75th anniversary of the start of the health service,and there are all sorts of ways to celebrate, from doing a 5k Parkrun For The NHS this Saturday, to going to church and thanking God for the health service, or concerts in local parks.
MPs are having their own run, but only 4k, presumably to show that political promises on the health service often come up short.
Most of these events have been organised to look as though the NHS isn’t spending huge amounts of corporate money on the anniversary, largely because the health service is in such a state at the moment that it wouldn’t chime well with patients languishing on record-breaking waiting lists.
The health service has long tried to look as though it’s not splashing cash.
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Back in the 1990s it briefed designers to come up with a logo that looked as though the organisation hadn’t spent more than about £100 on its branding.
The blue lozenge design by Richard Moon nonetheless became one of the most recognisable brands in the world.
But even though the NHS is as important in the British psyche as football and rainy weather, that doesn’t mean it has the same longevity.
At 75 years, the institution is in serious need of intensive care.
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After writing a book on its entire history, I can confidently say it is in its worst and most existential crisis of its life.
It’s not just that waiting lists are so high — 7.4million in England at the last count — or that doctors are about to go on yet more strikes over pay.
It’s also that public satisfaction with the health service has plummeted.
It’s worth noting that the British Social Attitudes Survey, which found satisfaction at its lowest recorded level of 29 per cent in 2022, also recorded continuing support for the principles of the health service.
Many powerful politicians have wanted to change the model for healthcare in the UK, including Margaret Thatcher, who boasted about her private health insurance, but all have eventually shied away because they have realised the public would never forgive them.
But this anniversary really is a chance for today’s generation of politicians to face up to the truth about the health service.
And that is that without serious reform, it may only exist as a concept in another 75 years’ time, with many patients opting to go private just to get timely treatment, and a shrinking of what the NHS can provide for everyone else.
One of the most powerful phrases about the NHS comes from its founder Nye Bevan, who wrote a book called In Place Of Fear.
The health service is supposed to exist in place of the fear people used to have of getting sick, because pre-1948 many didn’t have access to healthcare that meant they could be confident they would recover even from treatable illnesses.
Now, the fear is back that if you get sick or injured, the health service might keep you waiting for too long.
The five million people out of work with long-term sickness know that all too viscerally.
The 1948 NHS was set up to solve a problem of access to healthcare.
Much of the demand in the early years came from people who just needed basic healthcare — women whose birth injuries had gone untreated and children whose ominous coughs were now sorted out.
But now most patients have a complicated range of physical and mental problems.
Many are seen too late in their illnesses, often in a hospital rather than in the community or at a stage where their illness itself could have been prevented.
Politicians know that moving to a preventive model of care would make sense for the NHS.
Both Health Secretary Steve Barclay and his Labour opponent Wes Streeting have spoken at length about prevention.
While talk of reform is in vogue, it won’t be successful if we aren’t honest about what it would have to involve.
If you simply move the funding from one area to another then you have to face up to closing hospitals, which no one likes.
But health experts argue that you can’t just move money from acute, hospital settings anyway and into community or preventive services.
They say hospitals are already running too hot, at more than 90 per cent of capacity, which means they can’t lose funding.
So realistically there would need to be even more cash for preventive and community medicine.
Is that really something the British public would wear through more general taxation?
Or would something have to give, with the health service either offering fewer services or even charging for more of its work?
That is the question that no one in politics really wants to answer.
But refusing to do so isn’t a cost-free option, as it means the health service continues to lurch along.
Politicians also come up short on the reforms that would stop the NHS being so inefficient.
Its buildings are crumbling — a metaphor perhaps for the general state of the service — and in each hospital held together with scaffolding or propped up on stilts, thousands fewer operations take place every year.
The NHS has a staggeringly low amount of money spent on main- taining and constructing buildings compared to other developed health systems.
Along with the short staffing we finally saw moves to tackle last week,, this means patients get worse treatment.
And then, because of a decades-long failure to reform social care, those patients often can’t move out of hospital when they are ready.
The politicians “running for the NHS” this week are taking the easier option of a 4k route.
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But they’ve also been taking the easy option politically for too long too.
Time to shape up
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