For the NHS, it’s likely that history will keep repeating itself

Professor Martin Roland reflects on the NHS – past, present, and future – following his CCHSR Annual Lecture on the subject on 6th December 2016 at the University of Cambridge

There’s a well-known quote that history has a habit of repeating itself. This is especially relevant for the NHS. A number of the issues that occurred in the early days of the NHS, just after its inception in 1948, are still as relevant to the present day, and likely to continue in the future. To coin a well-known David Bowie album, “nothing has changed.”

Funding has been an ever present issue for the NHS. In its first two years from 1948 to 1950, spending doubled, and the question of how much money the NHS needs remains as relevant today as it was in 1950. When looking at funding for the NHS, it is important to note that the UK currently spends less in GDP terms on its health service compared to other countries. In actual fact, the NHS is widely admired by other countries and seen as being highly efficient and cost-effective. This perhaps casts a different narrative to the news headlines often written about ‘costly’ and ‘inefficient’ services provided by the NHS. Despite that we don’t seem to do so well on outcomes compared to some other countries.

Over the years a number of different funding options have been considered by successive governments as a way of getting more money into the NHS. When Aneurin Bevan resigned in 1951 as the health minister, he cited the government’s decision to charge people for dentures and spectacles as the reason. Since then a number of proposals to reshape how the NHS is funded have caused controversy and successive ministers have been unable to propose anything better than funding through general taxation.

Margaret Thatcher produced plans for compulsory private health insurance and a system of private medical facilities that would more or less have led to the end of the NHS. The plan was shelved after its contents were leaked and led to an outcry in the press, but the example serves to illustrate how previous governments have wrestled unsuccessfully with the idea of fundamentally changing the funding arrangements for the UK’s health service. They end up with the same conclusion that the Royal Commission on National Health Insurance drew in 1926, that funding out of general taxation remains the fairest and most efficient way to pay for healthcare. So it seems unlikely that there will be any radical change to this in the short to medium term. One way to raise additional charges would be to increase co-payment – e.g. payments to go and see the doctor, but the political risks would be very high for any party making the suggestion.

The NHS will always need more money, particularly with the range of challenges that it faces, which include rising costs and a growing elderly population. Indeed Aneurin Bevan commented in 1949 about the strains on the new NHS that had been caused by the ‘aged sick’, and not long afterwards, Cambridge academic C.W. Guillebaud led a government review of NHS funding which pointed out how medical care would lead to people living longer with what he called ‘slow killing diseases’. In many ways the rhetoric in the 1950s seems remarkably similar to today.

Governments will explore new ways to fund the NHS and will probably continue to look to re-organisation as a way of solving their problems (generally unsuccessful).  Any radical changes to the methods of funding the NHS are intensely political and major change risks widespread public discontent. As former chancellor Nigel Lawson said, the NHS is the “nearest thing the English have to religion.”

However, this doesn’t necessarily mean we have to be pessimistic. Despite many challenges and problems along the way, the NHS is still something of huge value. We need to remember how widely admired and emulated the NHS is in many other parts of the world.


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