NHS at 66: Inevitable Retirement?

In 1948 Aneurin Bevan, Health Secretary for the Labour Party, opened Park Hospital in Manchester, and, along with it, the doors to a free health service. Since then the NHS has seen a great deal of changes in medical history. In 1954 the link between smoking and lung cancer was distinguished. Six years later, in 1960, the first kidney transplant operation in the UK is discovered to be a success. These are but two of the groundbreaking medical advancements Britain witnessed in the early years of the NHS. From then on we can trace a trajectory of medical discoveries and successes, from the first ever heart transplant in 1968, to the first ever artificial heart implant in 2011.

Although it has much to be proud of, and has provided a free health care service unrivaled by many private services, growing concerns in recent years have threatened the sustainability of this service. In 1948, the annual expenditure on the NHS was £11.4bn. By 2010/11, that figure had risen to a gastronomic £121bn. Although the population has risen by around 16 million – from some 47 million in 1948 to now around 63 million, according to the 2011 census – the growth in population is not wholly accountable for the dramatic growth in NHS spending.

From the years 2005-2006, 2 of the 5 largest areas for NHS spending were Cardiovascular disease (at just over £6bn), and Cancers, (at just over £4bn). By 2011 these had risen again, with Cardiovascular disease at £7.72bn, and Cancers at £5.81bn. There are no figures for NHS spending in the year 1948, since it was not until July that the healthcare service was fully underway. However, in 1949 the NHS took up 3.3% of Government spending, whereas in 2011, it had risen 8.4%.

So why the increase in spending, and why did the Real term spending for the NHS exceed annual National income in and around 1992? One reason is the cost of treatments. The constant demand for effective treatments is intrinsically linked to cost. Drugs, various other therapies, and new and improved equipment all cost money. Another reason is wages. Wages of healthcare workers should increase faster than inflation. If the economy is experiencing a rapid increase in inflation, then the NHS has to tackle the issue of increasing pay, this can often prove problematic, considering the annual spending budget. One other reason, and quite an important one at that, is the ageing population, and the lifestyle choices of the people the NHS is treating.

Post-World War Two, Britain experienced a dramatic rise in population known as the ‘Baby Boom’. This generation, being born around the same time as the reforms in parliament in Attlee’s Labour government, one of which being the NHS, experienced a life of plentitude, free healthcare, a welfare state, and attractive pension schemes. Since this generation is now in its retirement age, and has been since increasingly over the past several years, it no longer contributes the large amount of taxes that were part of the NHS funding. Similarly, this generation are relying more and more upon the NHS because of underlying health problems linked to the ageing process. In short, the NHS is finding itself consistently and increasingly in demand, with no added funding to cope with these pressures.

Though it would seem this evidence is conclusive in diagnosing the struggles of the NHS in recent years, it is not fair to scapegoat the NHS dilemma on the aged. In 1948 the nation had never been healthier. Well thought-out rations, instigated by limited food supplies during World War Two, ensured that the nation was ‘super-fit’. Children were taller, infant mortality declined, there were fewer dental problems, heart problems were at an all time low, and the whole nation had a healthy distribution of important nutrients. Since then, Britain has seen an increase in convenience foods, an increase in the consumption of foods with high levels of salt, sugars, and saturated fats, and a less active lifestyle. As the NHS tightens its belt with an increase in cuts, Britain slackens its belt with an increase in waistlines. Returning to the figures that show an increase in cancers and cardiovascular treatments in the UK, it would seem that there is a correlation between the increase in NHS expenditure in treating these illnesses, and the continual growth of the average weight of a British citizen. Since 1980 alone, the average BMI of a British female has increased from 24.2 in 1980 to 26.9 in 2011, and the average British male: 24.7 to 26.6 respectively. The strains of a heavier and heavier nation, it would seem, are all too much to bare for the NHS.

When it was first established, it was a healthcare service designed to look after individuals from a healthy nation, but it has, in the space of less than 70 years, become a service that can no longer cope with the demands continually put upon it. Reaching its 66th year, older than the average age of retirement in the UK, will the NHS itself retire from the vital service it delivers to the nation? As a people who have become so accustomed and used to a free health service, do we no longer appreciate the NHS, a service that many other nations can only aspire to? One can hope that the legacy of Attlee’s free healthcare service will live on, but, because of the increase in demand put upon it by an increasingly unhealthy nation and unstable economy, it is only a question of time before the NHS buckles under the weight of so much pressure.