NHS will have great challenges to meet

Published on Friday 4 July 2008 22:08

TODAY marks the 60th anniversary of the founding of the National Health Service. The creation of a state-funded, comprehensive health insurance system is one of the great social gains of the 20th century. It is not just a matter of natural justice, with those who are able providing for those who cannot. The NHS has also ensured a common bond that has helped unite society in an individualistic age – which explains the continuing popularity of the institution.

If there is a possible flaw in the NHS it lies in the unique form in which it was created by Nye Bevan in 1948. Bevan deliberately conflated the provision of universal health insurance with a centralised NHS which delivered healthcare provision. No other country followed this road. In Scandinavia, for instance, healthcare is provided in a decentralised fashion via the local authorities, which ensures less bureaucracy. Other nations have chosen to provide tax-funded health insurance but leave the patient free to seek medical care from a mix of competing public and private providers, as in the highly effective French system.

The Bevan model continues to have repercussions. He gave hospital consultants the right to use NHS beds for private patients, as a device for splitting the consultants from GPs who were opposed to becoming NHS employees. The recent (and expensive) consultants' contract was designed to buy the NHS out of that early compromise.

Bevan was eventually forced to accept GPs as independent contractors. But it has taken another expensive new contract to bring the provision of GP primary care into the 21st century. As we reported this week, the massive financial cost of the new GP contract was underestimated by the NHS.

Spending on the NHS has doubled in the past decade. The public seems supportive of this investment, which could prove Gordon Brown's legacy. Unfortunately, a large amount of this money has been swallowed up in badly-negotiated contracts and wage increases necessitated by the need to modernise the creaking structure of the NHS. Certainly, there have been benefits for patients. The provision of hospital treatment is now state-of-the-art. Unfortunately these gains are being undermined by endemic hospital infections, the latter the result of pushing high numbers of patients through centralised wards.

No one can seriously argue that the introduction of universal, state-funded health insurance in 1948 was anything other than a good thing. But that still leaves open a debate on how best to provide healthcare delivery. In England, the government is swinging back to an emphasis on more competition. In Scotland, the consensus remains with a more centralised model.

The problem is that we are unlikely to see major increases in NHS funding in the next decade, while the cost of modern medical care continues to rocket. We should wish the NHS happy birthday, but not ignore the urgent task of making it function better.