Leader comment: NHS at 70 faces tough choices to ensure survival

Three score years and ten was once viewed as the natural lifespan of a human being, but while a baby girl born in 1948 could look forward to a life that long, the life expectancy of a boy was less than 66. Today, the respective figures for both girls and boys are about 10 years longer thanks, in large part, to the National Health Service, created 70 years ago today. Among its achievements, the NHS has saved countless lives from infection or injury, eliminated horrific diseases like polio from the UK, introduced comprehensive vaccination programmes, and enabled the birth of the world’s first IVF baby as well as many more. Its staff have become the heroes of modern-day Britain – nurses were last year voted the most trusted profession, with doctors a close second, while politicians came last – just below professional footballers and journalists. In The Scotsman today, nurse Pauline Cafferkey, who contracted Ebola while working in Sierra Leone, tells of how she was “astounded” by the care she received, with medical staff “putting their lives on hold and working round the clock” to save her. And she is not alone. The Commonwealth Fund, a US think tank, last year ranked the NHS as the best healthcare system in 11 leading countries, including the US, France, Germany and Australia. The UK’s total spending on public and private healthcare is about 10 per cent of GDP, lower than in the US (16%), as well as Japan, France and Germany (all 11%). So it would appear we are getting a top-class health service on the cheap; indeed, the NHS has been described in the BMJ medical journal as the “world’s most cost-effective healthcare system”. Yet, for all that, the NHS is clearly showing signs of decrepitude as it turns 70. Its success at enabling the average person to live an extra decade has created a vast amount of new work to keep the diseases of old age at bay. At the same time, bad diets and physical inactivity have produced a surge in rates of obesity and its associated illnesses with cases of diabetes alone threatening to overwhelm the NHS. While its funding has been increased by both Labour and Conservative governments, the extra cash has failed to keep pace with the rise in demand, leaving doctors and nurses increasingly over-worked and stressed out as waiting times for treatment have increased. Following persistent calls for her resignation, Shona Robison was replaced as Scottish Health Secretary by Jeane Freeman. However, we, the public, must share the blame. We bang the table to demand appointments and yet a staggering 1.7 million, about 10 per cent, of them were missed over the past 10 years at a cost of some £200 million. We insist on antibiotics when they are not needed. If we wish the NHS to continue as part of the fabric of the UK, then some tough choices may need to be made. And, on this, the public may be more accepting of the need for change than politicians realise. A recent poll found 75 per cent of respondents backed fining patients who repeatedly miss appointments. Plastic surgery for purely cosmetic reasons and other non-vital procedures may need to be cut or scrapped completely. Laws requiring a 5p charge for plastic bags resulted in 80-90 per cent falls in their use. So, unless we can be persuaded to stop putting so much pressure on the NHS, perhaps it is time to consider small charges for prescriptions and even GP appointments to make us all value them more. For if the NHS is ever lost, we will rue the day we lost sight of just how worthwhile it is.