Last week marked the 69th birthday of the NHS and, as is the case with most anniversaries, it provided a reason to reflect on what has been achieved and to contemplate what the future might bring. Today however, the positivity we saw five years ago, when the NHS was lauded at the London Olympic Games, has been replaced with a rising number of concerns over its funding and sustainability. I thought I would use this week’s blog to highlight some of the more positive milestones seen over the past 69 years and contemplate what we can do to ensure that the NHS can celebrate its seventieth birthday in robust health.
Sixty-nine years ago on 5 July 1948 Aneurin Bevan realised his post-war vision of a healthcare service available to all, regardless of wealth, and launched the NHS based on three core principles:
- that it met the needs of everyone
- that it be free at the point of delivery
- that it be based on clinical need, not ability to pay.
The fact that these principles have endured for 69 years is in itself cause for celebration. Indeed, until the introduction of the NHS hundreds of thousands of people couldn’t afford to pay to see a doctor and every year thousands of people died of infectious diseases like pneumonia and polio. Moreover, around one in 20 children died before their first birthday. The fact that today, both men and women live on average 10 years longer than they did before the creation of the NHS, is a real achievement. While the NHS is once again coming under increasing and unrelenting demand and performance pressures, the number of people being seen and treated is at an all-time high. Don’t take my word for it, just look at what the numbers tell us about the NHS as it approaches its 80th decade:
- the latest workforce count show that there are now some 1.7 million NHS workers across England, Wales, Scotland and Northern Ireland ( 1 in 20 of the UK workforce) and in many parts of the UK the NHS is the area’s biggest employer. Only the US Defence Department (3.2 million), China’s People’s Liberation Army (3.2 million), Walmart (2.3 million), and McDonalds (1.9 million) employ more people1
- The NHS budget for the whole of the UK for 2017-18 is £147.5 billion, more than 10 times what it was in 1948 (adjusted for inflation). This works out at some £2,264 per person. Moreover, many people cost the NHS much less, but others, if they had to pay, would find healthcare costs prohibitively expensive. For example, the most severe level of multiple trauma caused by a traffic accident costs £24,000 and a coronary artery bypass costs £10,037 based on 2015/16 tariffs2
- Activity is higher than ever before with staff across the NHS in contact with more than 1.5 million patients and their families every single day. Around 23 million people visit their GP or practice nurse every month, and a full-time GP treats, on average, 255 patients a week. In 2015-16 the NHS 111 service received around 20 calls a minute, and there were more than 9 million 999 emergency calls made and 50,000 emergency journeys by NHS ambulances per week. In total, some 745 million prescriptions are distributed each year.3
It is also timely to remember some of the key moments in the NHS’s history over the past seven decades – and while there are far too many to mention, I have focused on the one or two per decade that I believe were defining moments:
- The 1950s – crucial scientific breakthroughs. In 1953 Cambridge University scientists Watson and Crick revealed the structure of deoxyribonucleic acid (DNA) paving the way for the study of disease by defective genes and later, genome treatment therapy. Fast forward to 2017 when the cost of sequencing a genome has decreased significantly to $1,000 per genome, compared to $100 million in 2000.4 This important discovery was followed, in 1954, by Doll and Hill’s unequivocal findings of the link between smoking and lung cancer, which concluded that smokers of 35 or more cigarettes per day increased their odds of dying from lung cancer by a factor of 40.5 More than 53 years later in 2007 smoking was as finally banned in public places
- 1960s – women given control over reproduction. In 1961 the contraceptive pill was made widely available for the first time, and between 1962 and 1969 the number of women taking the pill in the UK rose from 50,000 to 1,000,000.6 Today it is estimated that around three million women in UK take the pill. Some commentators suggest that, the contraceptive pill is perhaps the greatest scientific invention of the 20th Century.7 In April 1968, the Abortion Act became law, allowing termination up to 28 weeks; this was lowered to 24 weeks in 19908
- 1970s – advances in diagnostics transformed our understanding of the human body. The development of CT computerised tomography scans in 1972 revolutionised diagnostics by offering three-dimensional images by combining a series of x-rays.9 This was followed in 1980 with the University of Aberdeen obtaining the first clinically useful image of internal tissues using Magnetic Resonance Imaging (MRI).10 Both are now invaluable diagnostic tools across the NHS
- The 1980s – the rise of transplantation surgery. In December 1983 the first UK heart and lung transplant was carried out at Harefield Hospital in London11; in 1987 the world's first liver, heart and lung transplant was carried out at Papworth Hospital in Cambridge, giving the patient an additional ten years of life.12 In 1994 The Organ Donor Register was set up following years of campaigning13 and in 2016-17 there were some 3712 deceased donor organ transplants carried out14
- The 1990s - a decade of many amazing medical inventions advancements. These included the Hepatitis C vaccine in 1992, the protease inhibitor in 1994 (a type of antiviral drug that treats HIV and Hepatitis C) and Viagra in 1998. 1996 also saw the cloning of the first mammal, a sheep named Dolly. She was born July 5, 1996, and lived to be six years15
- The 2000s – management and control of hospital acquired infections. In the first half of this decade there was an increase in awareness and understanding of the challenges presented by the rise in hospital acquired infections. The NHS set a number of national performance targets MRSA and C Diff infection reduction targets with financial penalties for failing to meet them. The second half of the decade saw impressive improvements in the management and control of these infections
- The 2010s – the rise of automation, robotics and the ubiquitous use of digital health technology. With the advent of the smart phone and wearables, as well as the development of AI and machine learning, is transforming healthcare. Described as the fourth industrial revolution, the exponential growth in computing power is poised to unlock something special. The NHS has been at the forefront of many of these developments including the 100,000 Genome Project.16 Other examples included the Academic Health Science Networks (ASHNs), Digital Health Technology Catalyst for innovators – and the Early Access to Medicine Scheme, which are all helping the NHS to integrate new technologies into everyday practices17
Against the above background, it is difficult to overstate the positive impacts that followed the introduction of the NHS. It certainly hasn’t been an easy ride, but having responded and treated the healthcare needs of all who have needed it for more than two thirds of a century, most consider the NHS to have been a real success. It has been described as ‘our jewel in the crown’ and seen as an object of admiration and envy around the world. Over the next few years, as we race towards its 70th anniversary, the challenges appear greater than ever before but so too is the spirit of innovation and the willingness to trial new models of care, and for staff to work differently. I remain optimistic that the NHS will survive and live to enjoy more than the 70 years that has historically been seen as the ‘normal life span’.