The NHS at 70
5 July 2018
Today marks the 70th birthday of the NHS. Paul Jenkins, Chief executive of The Tavistock and Portman NHS Foundation Trust, gives his view on the significance of this occasion.
The 5th July 2018 marks the 70th anniversary of the establishment of the NHS. As an institution the NHS is a concrete manifestation of the idea that we have a collective responsibility for the health of our fellow citizens. To my mind there are few things more indicative of a civilised society than our willingness to tackle the need and suffering of others. As such, the founding of the NHS is an occasion that deserves celebration, but I hope it is also an anniversary which provides a focal point for some critical debate about its future.
As a Welshman it is a source of pride that it was a co-patriot, Nye Bevan who was responsible for leading the establishment of the NHS. However, while Bevan brought about the creation of the NHS, it was William Beveridge who made the case for the NHS as part of a wider post-war welfare system.
During World War II Beveridge was given the task of reviewing the confusing array of sickness and disability schemes for workers. He quickly decided that there could be no coherent system of work benefits without also looking at the plight of women, the old and children. Workers after all were not alone – they had wives, children, they had parents and they themselves got old and sick.
Beveridge decided he needed to devise a system for everyone. This included family allowances, pensions, a National Health Service and the government would need to manage the economy to keep people in work to pay for it all. There could be no return to the mass unemployment of the 30s.
The NHS was not devised as an institution to stand on its own. Health is affected by education, income and housing as much as by healthcare. When Beveridge published his report ‘Social Insurance and Allied Services’, it sold over half a million copies – more than any government report before or since. As Britain survived its darkest hour it gave a vision of what we were fighting for.
The NHS opened its doors on 5 July 1948 and 13-year-old Sylvia Beckingham, who was suffering from a liver condition, became its first patient.
Around the country there was a flood of people to surgeries,
hospitals and chemists. Millions of people at the bottom end of society had
lived with untreated conditions rather than face the humiliation of being
unable to afford treatment. Now they could enter hospital and surgery waiting
rooms not as beggars, but as citizens with a sense of right. For the first-time
people could access healthcare without the fear that they would not be able to
Driven by a strong commitment to the public health goals of the NHS, and by the ambition to influence mental health practice across Britain, the Tavistock Clinic became part of the NHS in 1948.
When the NHS was founded in 1948, the life expectancy for men was 66, and for women, 71. Today those figures are 77.2 and 81.5 respectively. In the last 70 years the NHS has helped as ten years has been added to the average lifespan. This is a huge achievement.
Since 1948, as well as providing world class healthcare, the NHS has led the world in scientific breakthroughs. We have seen technological advances ranging from hip replacements and heart transplants to MRI scans and robotic arms.
These advances, however, come at a cost. The NHS budget has risen from £437 million (roughly £15 billion at today's value) in 1948, to £126.269 billion in 2018/19.
The next couple of years are a critical time for the NHS as it faces the simultaneous challenges of growing demand, the consequences of austerity and the uncertainties flowing form Brexit. I believe it is time to take a more fundamental look at some of the key questions facing the NHS and its development to ensure it has a sustainable future.
There is a pressing need to revisit the mission of the NHS and return to Beveridge’s integrated vision where no man is an island. We should reconsider how health operates within the system as a whole, linking with other areas such as education, social care and environmental planning. Social care, for example, is fundamental to the care of some of the most vulnerable people in society, whether frail elderly people or looked after young people. Education is critical for the best form of healthcare we know of: prevention.
Of course, the NHS exists to save lives, but I would like to see a greater emphasis on improving life chances and relieving suffering. In recent years we have seen life expectancy increase while quality-adjusted life-years have remained static. When much of what we can do to improve lives, in particular in the area of mental health, remains unfunded we should not assume that all future medical developments can necessarily be supported. Such choices will need rational and informed debates in society.
It is time to give parity of esteem to mental health. As the LSE highlighted in their 2012 report ‘How Mental illness loses out in the NHS’, the treatment of mental health problems accounts for 23 per cent of demand on the NHS but receives only 11 per cent of the funding. Such a shortfall cannot be tackled overnight, but a longer-term settlement for the NHS might commit, for instance, to eliminating this differential over a ten-year period. It has been good to see some commitment from the government to this goal.
The NHS has many strengths and it is full of many committed and inspiring individuals. Training and assembling such a workforce is a key challenge. We need to be much smarter at looking after our workforce. The recent Farmer/Stevenson report on mental health at work positioned the NHS as one of the sectors of the economy with the highest annual costs of poor mental health at work. We need to take account of the traumatic nature of working in healthcare and develop a more comprehensive system of support for staff in which the spirit of psychological understanding can permeate the entire system of the NHS.
Day in, day out NHS staff do some brilliant work supporting the millions of patients who seek its help. It is right to celebrate the 70th anniversary of this institution, but let’s be bold, like that post war generation was, in reenvisaging what the NHS should be like for the next decade.