Condition critical? Britain's beloved but battered National Health Service turns 75

It's unusual to throw a birthday party for a health care system, but that's exactly what the U.K. did for the National Health Service, a beloved but increasingly creaky institution that turned 75 on Wednesday.

The date was marked with charity tea parties, royal visits and a service of thanksgiving at London's Westminster Abbey complete with hymns and prayers. It was a fitting tribute for an institution that is often likened to Britain's secular religion—though one in which some people are losing faith.

Backlogs, treatment delays, funding gaps and an unhappy workforce have created an increasingly threadbare and overstretched system. Three respected health think tanks warned Wednesday that the NHS is "in critical condition" and won't make it to 100 without more money and better long-term planning.

"Pressures on services are extreme, and public satisfaction is at its lowest since it first began to be tracked 40 years ago," the King's Fund, Health Foundation and Nuffield Trust said in an open letter. But, they added, "despite this, public support for the NHS as an institution is rock solid."

Britain's affection for what politicians call "our NHS" is striking, and at times puzzling, to outsiders. Dancing nurses pushing children on hospital beds formed a key part of the opening ceremony for the 2012 London Olympics, to the bemusement of many non-British viewers.

Founded in a country determined to build a fairer society out of the ruins of World War II, the NHS provides free health care to citizens and residents, funded through taxation.

Its anniversary is also the 75th birthday of Aneira Thomas, the first person born into the new health service, just after midnight on July 5, 1948.

"I used to be introduced by my mother as 'This is my National Health baby,'" said Thomas, whose parents named her after the country's postwar health minister, Aneurin "Nye" Bevan, considered the father of the NHS.

"As a child, I didn't understand the significance of it," she said. "It was when I had children myself that I appreciated the care that I had."

Ellie Orton, chief executive of NHS Charities Together, a network of groups that supports the health service, said the NHS regularly comes up on top when people are asked "what's the thing that they hold most dear in the U.K."

"And when we ask them what's the career that they hold in the highest esteem, they say it's the NHS workforce," she said.

Critics say that affection prevents discussion of the flaws of an unwieldy behemoth that employs more than 1 million people and has struggled for years to cope with increasing life expectancy, rising demand and fluctuating political priorities.

Sajid Javid, who served as health secretary under former Prime Minister Boris Johnson, argued this week that the service was "unsustainable" but politicians are afraid to say so because most proposals for change—whether fees, higher taxes or major restructuring—are politically unpalatable.

"Without fundamental change, the supply of health care will continue to be unable to keep up with surging demand," Javid wrote in the Times of London, calling for an independent commission to look at reform options.

The U.K. is not alone in having a health care system under increasing pressure. Most wealthy Western countries—bar the United States—have built their health systems on a form of socialized medicine. The U.K. model is unusual in relying almost entirely on taxation rather than insurance or a blend of the two.

Since a Conservative-led government introduced public spending cuts in 2010 in the wake of the global financial crisis, NHS funding has grown by about 1% a year in real terms, apart from a surge during the coronavirus pandemic. But demand is growing much faster, as the British population grows larger and older.

The pandemic also sucked up resources, drained staff physically and emotionally, and created a huge backlog of delayed tests and treatments.

Britain's departure from the European Union in 2020, which ended the automatic right of EU citizens to live in Britain, made it harder to recruit medical staff from other European countries to fill staffing gaps.

The King's Fund compared health systems in almost 20 nations and found the NHS at best placed in the middle of the pack.

"The U.K. performs well on protecting people from some of the financial costs of ill health but lags behind its peers on important health care outcomes, including life expectancy and deaths," the health charity said in a report published last week.

All the main U.K. political parties pay tribute to the NHS and promise to protect it. Conservative Prime Minister Rishi Sunak, the son of a doctor and a pharmacist, gave a Bible reading at Wednesday's Westminster Abbey service, where the NHS was hailed by its chief executive, Amanda Pritchard, as "a cornerstone of national life and our shared identity."

But Sunak's government has been at loggerheads for a year with unions representing nurses, doctors and ambulance crews, who have staged a series of strikes to seek pay raises to match surging inflation.

Thomas, the NHS baby, worked as a mental health nurse in the NHS and remains a passionate advocate for the service. It treated her children when they were seriously ill and allowed her family a quality of care it could once only have dreamed of in the coal mining valleys of Wales.

"My own grandparents, I never knew them. Both sets died between the ages of 30 and 50," Thomas told The Associated Press. "In comparison, my own mother lived into her 96th year, and she would often say, 'Look what the NHS has done for me. I've lived to this age, I've seen my seven children grow up, my 21 grandchildren and 65 great- and great-great grandchildren.'

"It should be preserved, protected and cherished at all costs. It touches all our lives at some point."

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