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Burning the birthday candles at both ends

It’s been nice to see all the cakes and candles marking 70 years since the birth of the NHS.

The nerd in me can't suppress the need to point out though that whilst Nye Bevan was responsible for delivering a national health service in 1948, the conception part was down to the ‘Social Insurance and Allied Services’ report produced six years earlier by Liberal economist William Beveridge.

This landmark paper proposed reforms to eradicate what he called the “five giant evils of squalor, ignorance, want, idleness, and disease”.

Seventy years on, it’s difficult to evaluate if we’ve achieved that aim. I think this comes across in our own complex personal relationships with the NHS.

We lavish praise on its staff; berate its management; celebrate its history; allow it to spend billions; criticise it for perceived waste; rebuke it for failing to provide expensive and unproven treatments; expect to be seen by a consultant within days; count the ambulances outside A&E; raise our eyebrows at missed targets; protest against privatisation and demand value for money while enjoying free parking & prescriptions.

It’s those last examples which illustrate how, thanks to devolution and differing priorities around the UK, that we don’t actually have a truly National Health Service anymore. Although by far the biggest change is how decades of demand-led provision have given us a National Sickness Service where more attention gets paid to cure than cause.

It wasn’t always like that. By coincidence, this year marks the 170th anniversary of the 1848 Public Health Act. This key piece of legislation introduced public sewers, municipal refuse collection and street cleaning along with decent drinking water and the appointment of a medical officer for each town.

The ever-practical Victorians figured these modest measures would mean less cash going on poor relief for the families of men killed by infectious diseases. Spending money to improve public health was not just seen as morally right but also cost-effective.

The perspective has shifted in recent times. Whenever some preventative health measure is advised, you get the tabloid press clamouring about the ‘nanny state’. Nine times out of ten, it’s possible to trace those accusations back to vested interests or pharmaceutical firms who make a fortune charging hospitals £1,500 for a £2 pot of moisturiser.1

There are those who contend that a smoking ban would never have happened if the overall decision had been left to Westminster alone; such is the extent of corporate influence. It’s the same with arguments over alcohol pricing and controls on junk food.

Successive government administrations have caused the NHS to veer back and forth between being a target-obsessed bureaucracy or a market-orientated entity where everything has a price tag. Occasionally it does both.

The extent of political debate has descended into little more than making yah-boo comparisons in the Commons. Meanwhile, the impact of a ‘healthier’ nation is that we live longer and get more obese. These new demands on acute care are already causing chaos.

As the celebrations continue, I just wonder how much longer we can go on burning the birthday cake candles at both ends

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