On 7 September it will be be the three year anniversary of the passing of the Health and Social Care Act. I’m not sure how that anniverary will be marked but when the 67th anniversary of the founding of the NHS arose, someone dug out the Government document that announced it.
It’s worth comparing the language used in that with the tone of more recent ministerial announcements. Being written at a time when the country was bankrupt after the Second World War, the feeling is that as a nation, we are all in this together. The then Minister for Health, Aneurin Bevan, knew that when patients have to pay individually for every drug, service or procedure, clinical decision-making is corrupted, and valuable opportunities to improve the health of both individuals and whole communities are lost. He knew that a strong economy was based on a healthy workforce. ‘Illness is neither an indulgence for which people have to pay nor an offence for which they should be penalised, but a misfortune, the cost of which should be shared by the community,’ he said memorably.
The NHS has been phenomenally successful. It is the cheapest developed-world healthcare service, which achieves tremendous results on a population-wide level.1 It enjoys universal popularity among voters, when it’s allowed to work properly. It has advanced life expectancy beyond even the wildest dreams of the architects of the NHS.
But its model is under attack from a philosophy of privatization that aims to replace a system based on need with a system based on privilege. Of course general practice isn’t working particularly well right now, but that’s the fault of our politicians, funders and managers rather than a failing of the model. What’s happening now to the NHS was identified by Noam Chomsky as the standard approach when governments want to absolve themselves of responsibilities to their public: ‘defund, make sure things don’t work, people get angry, [then] hand it over to private capital.’ And just in case we were in doubt about the aims of private capital: ‘Privatization does not mean you take a public institution and give it to some nice person, it means you take a public institution and give it to an unaccountable tyranny.’
The NHS is in a bad place. One response would be to resign from it and go back to 1940s-style general practice, where wealthy individuals get excellent care, and the poor rely on charity.
I believe absolutely that would be wrong, and that as a profession, there are many more options to explore before we come to resignation. We owe it to our patients, and to our professionalism, to stick by them. The NHS is one of the most gloriously civilized ideas produced by the twentieth century – let’s not betray it.
Dr Gavin Francis is a GP and writer based in Edinburgh.
1 The Guardian. http://www.theguardian.com/society/2014/jun/17/nhs-health