It’s often hailed as the crowning glory of the post-war consensus. For many, it remains the national institution of which they are most proud. Healthcare, free at the point of use, for everyone – a wonderful concept admired around the world.
As the National Health Service reaches its 75th birthday, it’s an institution that continues to be held in high esteem and a source of national pride, despite the many challenges it faces.
Now is a time to celebrate the NHS and what it has achieved in the last three-quarters of a century, but also to look forward at how it can best thrive in the future – so it’s there for many generations to come.
Here, we briefly delve into its history and get a unique insight into what the NHS means to them from some of our team who have previously worked in the organisation itself for many years.
Free healthcare for all
The NHS was born on July 5 1948. It was a product of the post-war consensus, a time when – after World War II and Labour’s landslide general election victory in 1945 – the main political parties broadly agreed on policies to help the country recover from the devastation of war and the creation of a more comprehensive welfare state.
It was launched by the then Minister of Health in Clement Attlee’s post-war government, Aneurin Bevan, at the Park Hospital in Manchester, providing for the first time healthcare services that were free for all at the point of delivery.
Its early roots lay in the National Insurance Act 1911 and later the renowned Beveridge report, which spoke of a social insurance system ‘from cradle to grave’. The National Health Service Act was passed in 1946, bringing the NHS into being two years later.
A leaflet, titled The New National Health Service, was sent to every home in the country. “Everyone- rich or poor, man, woman or child– can use it or any part of it,” it said. A principle which still exists to this day.
‘Adding value back to society’
We are fortunate at Acumentice to have a number of ex NHS people in our ranks. In fact, our founder, Karina Malhotra, was previously a senior leader in the service.
Below, she – along with Stephen Hall (Director of Consulting Services), Philip Purdy (Principal Consultant) and Adam Ceney (Head of Analytics), who have many years of NHS experience between them – outline their favourite thing about the NHS, discuss the principle of free healthcare at the point of use and look ahead to where the institution might be 75 years from now.
What did you enjoy most about working in the NHS?
Karina: Knowing that you were ultimately doing this to add value back to society – helping patients get the best experience and outcomes made it worth the hard work! I personally also enjoyed working in high-pressure situations with complex decision-making required. It was also very rewarding to work with great people from multiple disciplines.
Stephen: It was amazing to work with highly-skilled people, in challenging situations, trying their hardest to provide high-quality care to patients.
Philip: The NHS has a lot of everything – people, science and technology, big budgets and investments, a lot of activity, plus a lot of potential for positively affecting people’s lives. It’s something we can all relate to and understand.
Adam: I was part of the Quality Observatory function, creating ways to use data to identify variation in clinical pathways and the domains of quality, safety, and experience. I enjoyed being able to build an evidence base for staff to focus on, deliver and monitor change activities that improved patient care and experience.
What do you admire most about the NHS?
Stephen: Free world-class care at the point of delivery for the whole population.
Philip: Contrary to what we sometimes hear, the NHS compares favourably to other health systems in terms of efficiency, and it does this whilst spending less per head than many OECD countries including Germany, France and the Netherlands. It does all of this whilst delivering so much universally and free at the point of use.
Adam: Despite social and economic changes over the years, it still finds a way of delivering services that compare favourably to other countries and free at the point of use despite spending less per head of population than most health systems. Just look at how the NHS responded during Covid to see how valuable an institution it is.
Karina: I admire its resilience (even post-pandemic) – and it’s the staff that deliver that. And the fact that it continues to offer world-class healthcare free at the point of use.
Is the principle of free healthcare at the point of the use still compatible with the modern world?
Philip: Absolutely. I think as a population we expect a lot more from healthcare than in previous decades and this has led to some difficult conversations about future funding, whether it is through universal taxation or top-up charges.
Adam: Yes, I’ll never get the argument that it isn’t. At times of medical need, people should not have to worry about how they will pay for it. This principle should always be the foundation for healthcare provision in the UK.
Karina: Yes, when it’s resourced appropriately. The UK still spends less on healthcare as a proportion of GDP compared to its European counterparts.
Stephen: Absolutely. However, it needs appropriate recurrent resourcing, and sophisticated demand and capacity modelling, bringing health and care data analysis together.
What needs to be done to ensure it’s still around in another 75 years’ time?
Adam: It’d be helpful if politics and the revolving door of new visions and re-organisations was taken out of the NHS. They cause more problems than they solve. If it’s agreed as a nation that the NHS should exist, free at the point of delivery, then it should be designed and managed as such. This includes building a workforce and services that can meet and sustain demand. Part of this would be to stop viewing the NHS as the National Illness Service, only enacted when treatment is required, and focus on prevention, so we change our behaviours to take responsibilities for our health.
Karina: The NHS needs to be resourced properly, clear workforce planning should include appropriate renumeration;, better governance which takes more of a long-term view of improvement rather than only quick wins;, a real concerted focus on prevention and reducing health inequalities and looking at and addressing wider determinants of health (through better population health analysis) to make it true to its name – the National “Health” service.
Stephen: The right funding. Comprehensive short, medium and long-term workforce plans. More focus on population health management (PHM) and appropriate up-to-date equipment, e.g., specifically designed software to efficiently manage patient tracking lists.
Philip: We must find a way of retaining and building the workforce so that it matches the demand for services – it’s the one thing that poses an existential risk to how the NHS runs, even above the money. If it cannot staff its services, then there will be an obligation to look to other systems and organisations who can.
The NHS certainly has much to be proud of over the last 75 years, but perhaps now faces its biggest set of challenges. It will require joined-up, long-term thinking (and more funding) to ensure it can keep up with rising demand and other obstacles. The recently announced long-term workforce plan is a start, but this – and other measures – need to be followed through in reality to make sure the NHS is still in fine fettle on its 150th anniversary.