The cult of the NHS is bad for our health

Seventy-five years ago today, the UK’s National Health Service (NHS) was founded – and a new secular religion was born. Indeed, the NHS has long been treated by our political and cultural elites more as an object of worship than as a public service.

This has made for a particularly cloying set of anniversary ‘celebrations’. Over the past month alone, we’ve seen a children’s choir sing ‘Happy Birthday’ to the NHS on the BBC’s usually dry Newsnight programme and the NHS make its Glastonbury debut. Today, the government has marked the big day with a celebratory service at Westminster Abbey, with prayers read by health secretary Steve Barclay.

The NHS is revered, especially among the leftish and Labour-supporting, like nothing else in British public life. As former Conservative chancellor Nigel Lawson famously remarked, it is the closest thing we Brits have to a national religion.

Or at least it was. Because right now the NHS’s sacred aura is most definitely on the wane. The political and media classes may continue to give thanks and praise to Our NHS, who art in Heaven. But the actual, real-life NHS on terra firma is repeatedly letting people down.

Cancelled appointments, postponed surgeries and bureaucratic cock-ups now define our interactions with the NHS, even more so than before. Scandals at assorted NHS trusts, which have cost countless lives, are all too frequently in the news. Many now genuinely fear that if they get ill or have an accident the NHS will not be able to treat them.

Current NHS statistics make for truly grim reading. Waiting lists stand at record levels, with 7.4million people in England in the queue to start treatment as of the end of April. More than 371,000 of those waiting have been doing so for more than a year. Demand has never been higher, and yet the NHS staffing shortage has never been more acute. In December 2022, there were 124,000 vacancies in NHS England alone, of which 43,600 were nursing positions.

This is why the NHS idolatry of much of the political and media class is now ringing increasingly hollow among the public. According to a recent survey from health charity the King’s Fund, just 29 per cent of people are satisfied with the NHS – the lowest rating in the survey’s 40-year history. The latest British Social Attitudes survey paints a similarly dismal picture, with the majority of the British public ‘dissatisfied’ with the health service.

The failings of the NHS ought to be impossible to ignore for our political elites. It is a morass of bureaucratic dysfunction – over-centralised and yet staggeringly uncoordinated. It is unable to cope with the growing chronic health problems that come with an ageing population. It suffers from a lack of investment in new technologies. And it continually faces a desperate struggle to recruit new staff, while current staff now seem to be engaged in perpetual industrial disputes.

There is so much that needs to be done, and so much that could be done, to improve the service offered by the NHS. Or even, dare I say it, to replace it with something much better. The question of how to radically overhaul healthcare – and social care, too – ought to be right at the top of the political agenda.

But it’s not. Not really. There may be the odd pledge for more funding or plan for future staffing, but no root-and-branch change is being seriously discussed. And that’s because the NHS is protected from any substantial criticism, let alone reform, because of its near-sacred status. It is almost too hallowed an institution to be seriously questioned.

Of course, even its devotees acknowledge its struggles. Indeed, they talk endlessly of the chronic underinvestment in the NHS and of the supposedly omnipresent threat of privatisation. Yet even when they’re penning their mournful op-eds, or tweeting pleas for more cash, the commentariat are still sacralising the NHS. They’re still treating it as something that we must ‘save’, indeed must serve, rather than the other way round. This inverted logic culminated in the government’s grimly absurd call to ‘protect the NHS’ during the pandemic. The government achieved this heroic feat by shutting down more health services during Covid than nearly every other nation in Europe.

This near demented sacralisation of the NHS among our elites owes much to the myth of its founding. Established by Labour in 1948 as a key plinth of its welfare provisions, the NHS has always been presented as the supreme achievement of British socialism. Indeed, that was how health minister Aneurin ‘Nye’ Bevan deliberately framed the NHS – as, in his words, ‘pure socialism, and as such opposed to the hedonism of capitalist society’.

Such slogans have long obscured the reality. To celebrate what is a creaking, dysfunctional health service as the crowning achievement of ‘pure socialism’ is ridiculous. If that’s true, it’s a more damning indictment of the British left than any arch right-winger could ever possibly muster. Anyone truly interested in boosting the lot of working-class people would not expect them to put up with and be grateful for such a woeful standard of healthcare.

As part of the welfare state, the formation of the NHS was also bound up with the desire to manage and organise the citizenry in the interests of the state. Indeed, it had been acknowledged for years across the party-political spectrum that the UK needed to forge a healthier, fitter population capable of labouring more productively. And of course, in those days, it needed people capable of ‘run[ning] an empire’, in prime minister David Lloyd George’s words, and fighting wars. It was no coincidence that the issue of healthcare came to a head in the midst of the Second World War, with the publication of the Beveridge Report (1942), the British welfare state’s founding document.

Clearly, there were many factors behind the establishment of the NHS. But to see it as some huge victory for left-wing politics, as so many left-wingers still seem to, is absurd. It’s nearly as absurd as the view taken by the British Medical Association in 1946, as part of its bitter battle against the NHS’s formation: its former chairman described the NHS ‘as the first step, and a big one, to National Socialism as practised in Germany’.

Few would dare say something as daft as that today. But then few would dare say anything substantially critical of the NHS today. Its sacralisation has effectively silenced even those one might expect to be critical. During the 1980s, when the Tory government was happily selling off public utilities and services, even Margaret Thatcher felt the need to announce that ‘The NHS is safe in our hands’.

The sacralisation of the NHS has effectively stymied any party-political debate about its future for decades. Labour has continually been in the process of ‘saving’ the NHS. While the Tories, terrified of being accused of pursuing privatisation, have continually been avowing their own faith. Throughout all of this, the NHS has continued to deteriorate.

This needs to stop. The public is still hugely in favour of the underlying principle of healthcare free at the point of use. No sane person is opposed to that. But the NHS is no longer living up to that principle. Millions are now struggling to access healthcare at all. The system needs a radical overhaul.

So enough with this talk of us saving or protecting or saying thank you to the NHS. We desperately need a health service that is fit to serve us. And we cannot wait another 75 years to get it.

Tim Black is a spiked columnist.