Eleven years ago this month, as part of the film-maker Danny Boyle’s gloriously inventive opening ceremony of the London Olympics, there was a sequence that paid tribute to Britain’s National Health Service, with dancing nurses and children in pyjamas bouncing on hospital beds. For many viewers in the UK, the ceremony – full of quirky humour and featuring hundreds of real health workers – stirred that very un-British emotion of pride in one’s country. Like the health service, it was inspired, said Boyle, by ‘a belief that we can build Jerusalem. And that it will be for everyone.’
It may have been a misty-eyed and nostalgic look at a Britain that perhaps never existed: the Conservative government of the day was hellbent on imposing harsh austerity measures on a country still recovering from the global financial crash and the riots of the year before. But, looking back on it last year, one commentator suggested it marked a last moment of national confidence and unity before a sad, fractious decline into polarised Brexit Britain and the growing feeling that the beloved NHS was itself in intensive care.
Though one conservative writer dismissed the Olympic scenes as ‘jarring and fantastical cult-worship’ of the NHS, many people in Britain would agree with the late Labour MP Paul Flynn, who called the ceremony a ‘worthy celebration of the greatest single political reform of the last century’. Born on 5 July 1948, and helped into the world by the Labour health minister, Aneurin ‘Nye’ Bevan, the NHS owed as much to a Liberal, William Beveridge, whose 1942 report formed the basis of a state that would look after citizens from the ‘cradle to the grave’. A health service that was comprehensive, paid from taxation and free at the point of use became the keystone of an entire welfare system. It also became a role model for those countries able to fund a national health service – most Commonwealth member states, of course, have pitifully poor levels of healthcare.
Public expenditure and its control – A commentary on post‐war finance 1950
Finance of the welfare state – The cost of the British social services 1948
‘Decade of under-investment’
Those principles, and the NHS itself, are under threat as never before. This week, as the 75th birthday of the NHS was marked (celebrated would be exaggerating), three leading independent health-research institutes wrote an open letter criticising ‘a decade of under-investment’ compared with the historic average and at levels ‘well below’ comparable countries.
The health service, they said, had ‘insufficient resources to do its job: fewer hospital beds than almost all similar countries, outdated equipment, dilapidated buildings and failing IT’. As a result, they noted, the UK had the second-lowest life expectancy among 19 countries analysed in a recent study, above only the US. ‘Inequalities in health are deep and growing – people in the most deprived areas of England can expect to spend almost two decades less living in good health than those in the wealthiest areas.’
A recent report from the King’s Fund, one of the thinktanks behind the letter, looked at the NHS and the health systems of 19 similar countries. It found the UK had below-average health spending per person and lagged behind in capital investment, with far fewer hospital beds, CT and MRI scanners; it had ‘strikingly low levels’ of clinical staff, who were paid less than in peer countries. To compare the UK with just the other Commonwealth countries in the study, the NHS has fewer nurses per head than Canada, Australia and New Zealand (where many fed-up British clinicians have gone), and fewer doctors than the latter two.
Studies by the Commonwealth Fund (no relation to the Commonwealth of Nations) put the UK top compared with 10 similar countries for care, access, efficiency, equity and outcomes in 2014 and 2017, but by 2021 it had slipped to fourth. Among Commonwealth countries, Australia was third overall in 2021 but first for equity and healthcare outcomes, and second for efficiency; New Zealand was first for care and third for efficiency, while Canada was far behind – 10th out of 11 overall, and ahead of only the US (consistently in last place).
Find out more about the Commonwealth Round Table and the Round Table Journal
Another Commonwealth Fund survey on burnout found 91% of UK primary-care doctors said their workload had increased compared with an average of 79% in Australia, Canada and New Zealand) and two-thirds of doctors aged 55 or older in the UK intended to stop seeing patients soon.
These sobering statistics are despite spending that is far higher than some of those peers. At 11.3% of GDP, expenditure on the NHS is higher than New Zealand and Canada on 11.2%, and Australia on 10%, according to the OECD, with other Commonwealth countries well behind, such as South Africa on 8.5% and India on 3%. Despite this relatively high expenditure, 70% of people in Britain believe charges for NHS care will be introduced soon, ending the founding principle of being free for users. This is despite three in four of those surveyed insisting that the NHS being free was ‘crucial’.
Canada, too, is largely free at point of care (appropriately enough for a country where a socialist government in the province of Saskatchewan pioneered universal hospital coverage four years before the NHS in 1944), but also faces pressure to allow a greater role for the private sector, such as in this comparison with Australian healthcare.
As countries in the global north look to the future of healthcare amid ageing populations, and rising levels of obesity and diabetes, there are constant calls from rightwing commentators for ‘reform’ of the NHS. And there are undoubted efficiencies and improvements to be made in every country’s system. After describing in glowing terms recent radical changes and improved health outcomes in Denmark, a Times investigation this month noted that the NHS still uses more than 600 fax machines and 79,000 pagers, while 12% of hospitals remain paper-based. It is true that robotic surgery could slash recovery times, artificial intelligence revolutionise diagnoses and administration, and tailored medicine may make cancer as beatable as infectious diseases.
However, the overhaul demanded by critics of the NHS require funding and long-term planning on a scale Britain’s Conservative government has not been prepared to envisage for the 13 years it has been in power. Earlier this year Rishi Sunak became the latest Tory prime minister to promise to save the NHS. But a Bloomberg analysis found ‘nearly every electoral district is failing to meet even half of the government’s key targets, and patients are subject to a postcode lottery that can affect whether they live or die in an emergency.’ To be fair, the opposition Labour party’s plans for the NHS were also met with some scepticism by leaders in the health sector.
As waiting times for emergency care increase, staff shortages mount and patients die in corridors for lack of beds, NHS staff and managers can only think about keeping the system going for another day, not about the integrated, community-based healthcare Denmark can boast. One hospital trust chief executive in England said: ‘It feels like we are locked into a death spiral. The challenges today are far greater than anything over the last 20 years.’
‘[David] Cameron and his gang will surely not dare to continue the dismemberment of the NHS after this,’ asserted one writer after the opening ceremony in 2012. But successive Conservative governments did continue to chop and slice away at it, just like they tried to scrap the NHS tribute at the Olympics. The NHS ranks highest in a survey of what makes people most proud to be British – above the country’s storied democracy, culture and history. How tragic it would be if this treasured birthright was allowed to collapse.
Oren Gruenbaum is a member of the Round Table editorial board.