“We tend to think the NHS will always be there” – Liberation

Sally Sheard is a historian and health policy specialist at the Institute of Population Health. For her, the difficulties of the British health system, the National Health Service (NHS), are manifold: lack of funds, the population living longer and teams with little incentive to stay.

Why is the NHS one of the pillars of British identity?

The NHS was established in 1948, at a critical time for the UK and at a time when many people were concerned about how they were going to pay for medical care. Its design began during the Second World War and was presented to the British public as part of a welfare state project which would “everyone, from the cradle to the grave”. This was part of a process to secure income, education, housing… The public quickly understood that this was a system to be loved, to be defended, and the NHS became an integral part of the set of British values.

How to explain the current crisis of the NHS?

The crises are many and all raise the question of the political will to provide the NHS with a sufficient level of resources to enable it to operate effectively. The main crisis concerns personnel: there is a massive exodus of clinical and nursing personnel, and it is becoming very difficult to provide basic services. The workload is heavy for those who stay. Teams are being asked to work unrealistic hours and there is a lot of stress and fatigue. Senior doctors retire early because they are financially discouraged from staying.

Part of the problem is precisely the success of the NHS: people are living much longer than before and develop co-morbidities at the end of life. There are also many lifestyle related diseases. Radically restructuring the NHS would require investment in preventive care which would therefore reduce treatment costs. This is politically unacceptable, as there would be no return on investment in a policy cycle.

Is privatization part of the problem?

Privatization was introduced in the 1980s as a way to generate greater efficiency within the public health system. If there was any logic to this, the risk in opening up the market to external providers is that they are only interested in those parts of the service where they can make a profit. If you break up a NHS like this, involving a large number of private companies, you destroy its ethics. Also, there hasn’t been enough budget under the governments we know since 2010.

What are the solutions?

We need to go back to basics and make sure we have sufficient training and professional development opportunities. Government and society also need to make a focused assessment of what the NHS can achieve and the value we place on it. We tend to think it will always be there because we have had this service for seventy-four years and have become quite complacent.