From Bevan to Bengoa: the NHS at 70

On 5 July 1948 the National Health Service was launched by the Health Secretary of the day, Nye Bevan MP, at Park Hospital in Manchester.

 It was founded on three core principles: 

1.      To meet the needs of everyone;

2.      To be free at the point of contact;

3.      To be based on clinical need and not the ability to pay.

Since then, the NHS has helped eradicate diseases such as polio and diphtheria, linked smoking to cancer and pioneered new treatments, such as the world’s first liver, heart and lung transplants. In recent times, it has been at the forefront of innovations, be they bionic eyes to restore sight or surgical breakthroughs such as hand transplants.

As it celebrates its 70^th birthday, we must also recognise that the NHS is faces significant pressures, most of which were unforeseen in the time of Bevan. With over £140 billion spent on health in the last year, the service is now incomparable with what was first envisaged.

A recent report by the Nuffield Trust reflects commonly held concerns within the NHS, and, critically, notes that it is a below-average performer in preventing deaths from heart attacks, strokes and cancer. That assessment, however, also highlights positives. The NHS is available to more people, protecting them from heavy financial costs, and continues to capably manage long-term illnesses – diabetes for example – in comparison with health services in similar countries. 

While the impact of a “Brexit dividend” – that recently announced birthday present from the government – is yet unknown, this is unlikely to make any serious inroads when it comes to retaining and attracting new staff or accessing drugs post-Brexit.

Locally, the NHS faces not dissimilar pressures. After numerous reports, plans and reviews, the 2016 Bengoa Report led to the creation of Health and Wellbeing 2026: Delivering Together. This initiative will undertake transformation of the health and social care system, and is resourced through a £100m budget. 

From tackling hospital waiting lists (not necessarily transformative), through to investment in children’s social services and the roll-out of multi-disciplinary teams in GP practices, combined with a workforce transformation strategy, everything seems to be heading in the right direction.   

That said, the absence of an Assembly and Executive has had an impact on the health and social care system. Numerous decisions requiring ministerial approval, including access to new treatments, are yet to be progressed. The transformation process may be underway, but the daily challenges facing the sector are growing. 

As Westminster’s Northern Ireland Affairs Committee recently recommended, there exists a need for some form of decision making, whether it is by local ministers, within a re-established Executive, or by the Secretary of State. Either way, patients and staff cannot be left in limbo.  

Has last week’s announcement from Downing Street, in which the government confirmed its intention to review governance in Northern Ireland, paved the way for soft direct rule, thus allowing decisions to be taken?