The NHS is not a religion – we should stop treating it like one

Like all the best quotations, its provenance is contested, but it was probably the late Tory chancellor Nigel Lawson who remarked that: “The National Health Service is the closest thing the English have to a religion, with those who practice in it regarding themselves as a priesthood. This made it quite extraordinarily difficult to reform.”

Tellingly, he made the remark – not meant entirely unkindly – some time after he had retired from office, and there remains a remarkably stable and predictable inverse relationship between advocacy of radical reform for the NHS and proximity to a general election.

Sajid Javid, a former health secretary who is standing down at the next election, and Sir Tony Blair, who has also “been there and done that” (and collected some scars on his back along the way), can freely speak their minds about fundamental change and reform.

But the present generation of politicians must be far more circumspect – at least in public. Steve Barclay, the present health secretary, talks soothingly about “evolution not revolution”, while neither Rishi Sunak nor Sir Keir Stamer seem to want to greatly challenge the status quo.

And that is what is wrong with the NHS as it celebrates its 75th birthday. The well-founded national respect and affection for the health service has induced a kind of phobia about doing things differently. Yet, like any other 75-year-old looking forward to their centenary, there’s good reason to take a moment to contemplate how best to make it to the next milestone.

It seems strange to anthropomorphise, indeed deify, a public service this way – schools, care homes and job centres don’t get presents and prayers on their anniversaries – but it just proves the abiding wisdom of the Lawson dictum. The NHS, for all the best reasons, has been given its very own service of thanksgiving in Westminster Abbey, in the same spirit of gratitude with which the late Queen awarded it the George Cross for the extraordinary courage and service rendered by its staff during the pandemic (with some even making the ultimate sacrifice).

The dean of the abbey, the Very Reverend Dr David Hoyle, proclaimed that “born of the radical conviction that we must care for one another, the NHS sets before us all the better angels of our nature. Here is high principle translated into best practice”. The NHS has literally received the blessing of the church. That does mean talk of its shortcomings feels a little bit like blasphemy.

Yet the ideals about delivering heaven on earth must feel strange for anyone having their operation cancelled at minimal notice, a half-day wait in A&E, or their meeting with the consultant postponed. If the basic principles underpinning the service – care, free at the point of use and paid from general taxation – are to be protected, then some more radical thought about how the nation spends the £200bn health budget is needed.

No one wants another top-down reorganisation because they usually lead to no tangible improvement in clinical care. But there may be a better and more responsive way to prioritise resources between the providers and users.

As Sir Tony suggests, the private sector could usefully be deployed to fill the gaps in the service, helping it through crises and to reduce waiting lists – as was done with some success under New Labour. Mr Javid’s suggestion of a royal commission is also worth taking up. There is surely nothing to fear from a dispassionate inquiry into how the NHS can learn lessons from socially inclusive healthcare systems in the rest of Europe, for example.

Any recommendations from a commission such as that would be years in the making, and backed by research and evidence – but still necessarily subject to democratic assent. If the British people still don’t like elements of, say, private insurance or optional “top-up” payments, then they won’t be introduced: yet the debate is worth having, even if it only demonstrates the superiority of the British system.

The challenges facing the NHS are all too familiar, now exacerbated by Brexit and the lingering effects of the pandemic. To offer one statistic: there will be three times as many centenarians around in 2048 as there are today, indicative of a population living ever longer but not necessarily in the best of health.

New drugs and treatments appear, some cheap but others expensive. The new long-term staff plan highlighted a historic lack of planning as well as shortages of labour. Persistent strikes speak to stress on the wards and poor staff retention. And economic growth in the short to medium term at least looks too anaemic to support improvements in services as things stand.

Yet there are good reasons for hope and optimism. Wes Streeting, for example, signals a willingness to be more creative than some of his colleagues in the Labour Party and outside. The shadow health secretary commits heresy when he argues that “the NHS is not the envy of the world. It’s a service not a shrine. We’ve got to stop thinking of it as a national religion and make sure that it is an institution and a system that delivers the best outcomes.”

He wants to radically alter primary care and the GP system, and switch to much more screening and preventative interventions, to help prevent the NHS from being a mere “reactive national sickness service”.

The reduction in smoking in recent decades, pushed by punitive taxation and bans in public spaces, must have saved billions already. AI can boost timely diagnosis, saving time, lives and money; and revolutionise the discovery of vaccines and drugs.

There is much more in a similar vein that can be done, but more uncomfortable choices for the voting public and politicians also lie ahead. For now, though, we may give the carers a round of applause and wish them many happy returns.