On the 75th birthday of the NHS, it's time to fix British health care

When it comes to Britain’s National Health Service, I am irremediably biased. It’s is a good thing. I have the scars to prove it. NHS surgeons saved my life when I was three weeks old and needed an emergency operation. When I was old enough to understand what the initials “NHS” meant, my grandmother, a feisty Glaswegian, would explain how lucky I was to have been born when my operation was “free”. She said that if she herself had been as ill as a baby she would have died. Her generation and class could not afford the hospital care I received. Of course, my grandmother knew my treatment was “free” only at the point I needed it. The NHS is based on a system paid for by taxation , disapprovingly called “socialised medicine” by some in America. Fortunately, British health care outcomes are statistically better than those for the US . (Have a look at perinatal mortality figures – deaths around the time of birth – for example. American outcomes are shocking.) But as a strong supporter, I have to point out the British are sometimes deluded that the NHS is the “envy of the world”. It isn’t. And so, as we celebrate the 75th anniversary of the founding of the NHS this week, we have to understand that the entire British healthcare system needs to be rethought as well as re-financed. The good news is that the NHS remains the public service with the highest level of trust among British people (80 per cent). It is also the country’s biggest employer, with more than 1.5 million full-time-equivalent staff. The not so good news is that the NHS is in big trouble and millions of Britons now complain about a deteriorating service. It has seen months of strikes by nurses, doctors and other staff , plus constant political rows about how to fix health care in Britain, which, after improving in the years up to 2010, has deteriorated as a result, in large part, from government economic austerity, as well as a growing population living longer. Getting a doctor’s appointment, finding an NHS dentist, ensuring rapid hospital treatment for non-emergency cases are all areas where the NHS has often failed. Moreover, the British political class has for years – I would suggest decades – adopted a sticking plaster cure to fix chronic failures. Neither Labour nor the Conservative party (for different reasons) has wanted to force through bold reforms for the next generation. That may now be changing. Prime Minister Rishi Sunak set out five pledges when he took office. He would halve inflation , grow the economy , reduce debt , cut NHS waiting lists and “stop the boats” – the people trafficking across the sea from France . None of this is working as Mr Sunak hoped. But last week he did unveil an NHS reform plan which appears to be for the next generation rather than – as with his other pledges – merely for the next election (probably in late 2024) or the next day’s newspaper headlines. In broad terms, Mr Sunak wants to fast-track the training of doctors and nurses and expand the NHS by as many as 300,000 new staff with a programme stretching over 15 years. There is a promise of easier access to primary care, a bigger role for pharmacists and others who are not trained doctors, more personal access to medical records and an NHS bureaucracy which will be more joined up and quicker to respond to patient demand. I hope it works. Wes Streeting, the health spokesman for the opposition Labour party, has implicitly praised some of the plan by accusing the government of “nicking” good ideas from Labour. Even so, there remain structural and ideological as well as political problems. On the political left, many believe the Conservatives really want to privatise health care and replicate the American model. On the political right, meanwhile, there is the not-entirely-unreasonable criticism of the NHS that it is hugely bureaucratic, slow to change and needs an administrative and organisational shake-up. For example, one NHS insider told me of a kind of bureaucratic sclerosis within the NHS on information technology and the use of computers. He said that the coronavirus emergency helped force more IT modernisation in two years than in all the reports and recommendations of the previous 20. Even if the insider was exaggerating, you get the point. Moreover, training a lot of new doctors is fine, but retaining existing doctors – who may find better pay and conditions by moving to Australia or North America – is proving to be a real problem. And so happy birthday, NHS. Britain needs you and loves you – but also needs you to understand the diagnosis. The future of the NHS does not depend merely on goodwill, pride, trust or even money. The future depends upon change and a strategy for health care financed properly for the 21st century. This cannot be the NHS of my grandmother. It has to be an NHS fit for the generation of our grandchildren.