Happy 75th, NHS

Health & Education


It would be difficult to miss the 75th birthday of the NHS this week.  

The milestone birthday has provoked plenty of commentary and adhoc examples, largely positive, but also negative on the support it provides, alongside recognition of the issues it faces day to day and long term. 

A recent BBC article gives an interesting summary of some of the fundamental issues facing the NHS and approaches that might be possible. To summarise a few key points: 

Fundamentally, the baby boomer generation is reaching old age, and whilst lifespans have extended, only party of this is due to better health and diet:  

“Life expectancy gains since the NHS’ creation have not been matched by increases in healthy life expectancy – on average, people are now expected to spend more than 20 years living in ill-health, according to the Office for National Statistics.” 

“The ageing population means huge numbers of people are living with chronic health problems, such as heart disease, dementia and diabetes that require long-term care and for which there is no cure. 

It is already estimated about £7 out of every £10 spent in the NHS goes on people with these conditions. On average, those over 65 have at least two.” 

With an accumulated health deficit from lifestyles led much of the future demand on the NHS is already visible. 

Reading a few articles and listening to radio dial in shows with a mixture of knowledgeable experts and armchair pundits with a range of views, experiences and political standings, it is clear that some fundamental change is needed to make it fit for the future. What is less clear is the plan to do it. 

If some of the comments heard on the radio in recent days are anything to judge by (even accepting those dialling in may have stronger views than the general populus), we have too much blaming and politicisation of the issues, issues which are fundamentally consistent, whoever is in power. And of course the NHS is a political football, despite the laudable cross party committees that operate more quietly in the background of the headline grabbing party campaigning. 

Humans as a rule prefer the status quo and people can get riled up quickly by one side or another.  The reality is we have to improve efficiency [ ] across the NHS.  

Clean thinking is needed, with a removal of people’s “sacred cows”. The following isn’t an exhaustive list, but: 

  • Penalties/sin taxes: If a 5p (now 10p) tax on plastic bags can bring down usage by 97%, why wouldn’t you consider it in other situations and the NHS? 
  • Charging at point of use: Emotive to some people, but generally people are talking about a small charge for a GP appointment, to try and reduce the huge number of missed appointments – According to , 15.4 million GP appointments are being wasted each year, meaning 5% of annual GP sessions being missed without enough notice to invite other patients, pushing up waiting times for others.  
  • Use of the private sector: to quote many armchair pundits “all the profit going to private companies is going to waste”! Of course this is a personal, political perspective (though, we note, thankfully one not shared by reasoned commentary from Alan Milburn, formerly Labour health secretary under Tony Blair, on LBC yesterday). This perceived “wastage” of money spent on private sector profits is missing the tremendous benefits and value accreted by using the private sector: Expertise and Investment. 




In most businesses, directors intending to sign a legal document would refer to their lawyer, bringing in skills and a perspective that are not available in-house. Outsourcing works in similar ways for other services and sectors, bringing in skills and different approaches that can result in higher quality in particular areas.  


The private sector (as a whole and not just the successful ones that actually end up making profits) is taking a long term investment decision, whilst the NHS is trying to plug the gaps to a degree and cannot be so entrepreneurial. Yes this is ultimately largely driven by expectations of financial reward, but at the same time it is taking on risk which the NHS doesn’t have to cover. 

This investment is more effective within the successful  healthcare businesses, to a degree because they start with a clean sheet, which brings huge benefits relative to the NHS, where modes of working have been engrained over time. If private businesses think there is a more profitable way to provide the same, or arguably better care, they will actively develop a plan to invest and implement. 

Finally, this profit is generally not the expense to the NHS but rather a saving. The budget impact is not the profit “passed” to the private sector, but the relative price paid out of the NHS budget for doing something using NHS resources v non-NHS resources. Unsurprisingly the private sector can do certain things more efficiently than the huge behemoth that is the NHS. 

Happy Birthday NHS…and as Spock would say “Live long and prosper!” 


By Richard Hall on 07/07/2023