How should a Western society treat those who lack the funds or family support to care for their health? This issue has faced the West for centuries, with Western nations devising various solutions. The difficulty with any solution is appropriately balancing the desire to ensure that no one is excluded from the benefits of modern medicine with man’s right to be his own master apart from state control. The United Kingdom’s answer to this question was to form the National Health Service, or NHS. Founded in 1948, the NHS was designed to provide free, universally accessible healthcare to the British public. Over its 73 years of operation, the NHS has found a special place in Britain’s heart, demonstrated by the nation’s willingness to lockdown during the COVID-19 pandemic to prevent the novel coronavirus from overwhelming the system. Despite these measures, the NHS has not escaped unscathed and now faces a slew of significant problems. As a result of the COVID-19 pandemic, the United Kingdom has a unique opportunity to evaluate the NHS and take action to shape its healthcare system for the years to come.
Charting the Past
To fully assess the situation of the NHS and create wise policy for the future, one must understand its history, purpose, and structure. Since the Church of England separated from the Roman Church in the sixteenth century, England has had some form of state-sponsored care for the less fortunate. In the twentieth century, the Second World War predicated the creation of the Emergency Medical Fund in 1938, centralizing the hospital system across the country to better cope with the expected war casualties. After Churchill and the Conservatives lost the election in 1945 to the Labour (left-wing) party, the new government formed the NHS in 1948, in line with the vision laid out in the Beveridge report for post-war Britain in 1943.
The stated purpose of the NHS remains much the same to the present day: to provide the British public with healthcare that is free, comprehensive, and available to anyone at any location. Perhaps unsurprisingly, this plan was immensely popular, with 95% of doctors joining the NHS in the first year. Doctors registered 30 million patients, while opticians prescribed 5.25 million spectacles at the cost of £32 million, vastly exceeding the original £1 million budget. In 1947, the NHS prescribed 7 million prescriptions per month, which more than doubled by 1951, reaching a rate of 19 million prescriptions a month. During the 1950s, the NHS continued to expand, offering vaccinations, hip replacements, and brain and body scans. Beginning in the 1960s, the NHS also emphasized preventative care, advocating for healthy living to reduce the need for medical treatment. Success came only through compromise, however, for many doctors did not desire to become employees of the state. After debating this issue, all parties concerned agreed that doctors could run their surgeries privately while establishing a contract with the NHS. Despite some disagreements, overall, the NHS fulfilled its expectations.
The NHS is divided into three primary parts: Primary Care, Hospitals, and Community Health Care. Primary Care includes the mainstay of any healthcare system: the GP surgery, which is usually the first rung on the ladder of medical treatment. The GP (General Practitioner) will treat a patient’s issue if it is a basic one or refer the patient to a hospital or specialist surgery if it requires a higher level of expertise. GP visits are, with minimal exceptions, always free. Primary Care also contains the medical services of dentists, opticians, and pharmacies. Unlike the GP surgery, adults over 16 years of age are required to pay for these services unless exempted because of extenuating circumstances. The second branch of the NHS is the Hospitals. Two-thirds of the NHS budget goes to this branch, helping ensure that treatment there is always free. Finally, the Community Health Care branch advocates for preventative care, provides education about healthy living, and coordinates with the government. Although this tripartite structure has varied over the years, the fundamentals remained the same and have supported the NHS into the twenty-first century.
Britain’s decision to leave the European Union in 2016 prompted two snap General Elections due to the government’s internal division: the first in June 2017, and the second two years later in December 2019. Boris Johnson and the Conservatives emerged with a majority victory, promising, among other things, extra funding for the NHS to improve its services. The government pledged 20 hospital upgrades, 40 new hospitals, 50,000 more nurses, 6,000 more doctors, and 50 million more GP appointments each year. Additionally, they increased funding to £34 billion per year, planning a 29% percent boost to funding between 2018 and 2023. To attract new talent to meet these goals, the government has promised the creation of an NHS Visa to fast-track medical doctors and nurses who want to work in the United Kingdom. Finally, they pledged an extra £1 billion for social care per year. These campaign promises are a testament to the British public’s value of their NHS and the government’s recognition of the political expediency of capitalizing on the mass of public sentiment.
Charting the COVID-19 Impact
This modern human right of healthcare was put to the test when the novel coronavirus COVID-19 swept around the globe. The pandemic caused great stress upon the system, and the repercussions will last for years, for regardless of how the NHS looked on paper, it was not without its shortcomings even before COVID-19. It suffered from various problems, such as old buildings needing costly refurbishment or replacement, waiting lists for treatment, unequal access across regions and social classes, and administrative troubles. Additionally, the NHS had a low number of Intensive Care Unit (ICU) beds compared to equivalent international nations and was understaffed compared to the rest of Europe. This situation was not ideal for coping with the arrival of COVID-19, as hospitals were stretched to capacity, and the NHS was forced to expand the availability of ICUs. The NHS achieved this by discharging patients and postponing non-urgent elective procedures, with estimates of the number of affected patients ranging from 100,000 to 13 million. The COVID-19 pandemic exposed and exacerbated underlying problems in the NHS, prompting perhaps the greatest display of support for any system: lockdowns.
Although the UK government was initially wary of locking down the nation due to the economic impacts, they eventually gave in, issuing the first national lockdown on 23 March 2020. The main reason the government gave for the lockdown was to prevent the NHS from becoming overwhelmed. Prime Minister Boris Johnson explained in his address to the nation that, “Without a huge national effort to halt the growth of this virus, there will come a moment when no health service in the world could possibly cope; because there won’t be enough ventilators, enough intensive care beds, enough doctors and nurses.” The government encapsulated the lockdown in its short, pithy catchphrase: “Stay Home. Protect the NHS. Save Lives.” Throughout 2020 and 2021, the government enacted sporadic national or local lockdowns, all designed to protect the NHS. The UK demonstrated its devotion to its healthcare system by willingly staying home and surrendering everyday life throughout the last two years.
Locking down the country, however, caused further problems to the NHS and the UK economy. During the pandemic, visits to Accident and Emergency (A&E; the UK equivalent of the ER) halved. More seriously, Cancer Research UK estimated that 2,700 cancers were missed every week during lockdown because of the single-minded focus on dealing with COVID-19. Once vaccines were approved in December 2020, the NHS expanded its focus to include vaccinating the whole of the British population. The NHS was incapable of continuing regular service while dealing effectively with the coronavirus, and its priorities shifted substantially.
Charting the Future
Debating the various merits of this decision is a discussion for another time, but it nevertheless prompts the question, “What next?” The NHS cannot indefinitely continue under-funded, understaffed, under-equipped, and facing year-long delays if it wishes to provide a modicum of decent service. According to a recent government report, wait times have risen, with 5.5 million people listed for various non-emergency visits. Something must be done. Several options exist going forward: privatize the NHS, restructure and rehaul, or pump more money into the existing structure. The latter alone will not work, for it does not target the heart of the issue. Instead, extra funding must be incorporated into one of the other two options. As for the first option—abolishing the NHS and creating a Singapore or American-style private system—public support is minimal, to put it mildly. A recent survey sponsored by the King’s Fund found that, even with its problems, the NHS enjoyed 60% public support. Other reports vary on precise numbers but indicate a general trend that people value the NHS to some extent. People not only value the NHS but also want it to remain in the government’s hands: A 2017 YouGov survey found that 84% of responders wanted the NHS to be run by the public sector, with only 5% desiring privatization. Britain may face an opportunity to alter its healthcare system, but, realistically, it will only make changes in one direction: reform and rehaul.
In March 2021, the government and the NHS set out their COVID-19 Recovery Plan while continuing with their NHS Long Term Plan. These plans include £8.1 billion to aid the industry in its recovery and £2 billion this year alone to rectify the elective backlog. Additionally, the government will further emphasize preventative healthcare to keep people out of the hospital and ease the burden that poor health choices place upon the NHS. To pay for these massive funding boosts, the government will raise dividend tax rates by 1.25%. All these plans aim to improve NHS operations and create a viable system once again. The most significant changes appear to increase funding and shift or increase attention in certain areas. Rehauling the NHS in this way charts a new path for the service, one that should be more efficient and better equipped as the country enters the next decade. The pandemic may prove to be the catalyst for change, as it exposed the underlying problems with the NHS and necessitated new policies to address those weaknesses.
Britain faces a unique opportunity to take stock of its healthcare system and decide its future as the country sails into new waters after Brexit. Politicians must make wise decisions to serve the people and safeguard their health without wreaking economic ruin by overspending. Since privatization is not an option in 2021, the reorganizations must be effective, efficient, flexible, and transparent to ensure that the NHS is of the people, by the people, for the people. Most of all, the NHS needs to lose its tendency to over-bureaucratize and to use taxpayers’ money well. Prudent leadership should keep the NHS on track to be a solid solution to the healthcare debate. While Britain needs the NHS to work well as long as it lasts, the West should not stop considering how it can best serve its fellow man when he falls ill. This question may be difficult, but answering wrongly has enormous repercussions economically, politically, and socially. Familiarity with any method must never prevent flexibility and adaptation if better solutions arise. As with any public institution, the British public must demand that the NHS perform, and insist on reform or, if necessary, abolition if it fails. The world must not lose this opportunity COVID-19 has brought to discover new solutions that improve healthcare systems for all people.
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