Comment Blog 5 July, 2023

A health check for the NHS's 75th birthday

Sebastian Rees
Senior Researcher

When we turn 75, it's customary for our GP surgery to invite us to have a seniors health check. To celebrate the NHS’s 75th birthday, we thought we would do the same for the Service itself. So here it is — our assessment of one of Britain’s most important senior citizens. 


We’ve run our usual tests — we’ve taken your bloods, measured your height and weight, and have your responses to the patient survey.  But because you’re a systemically critical patient we’ve also run a few more diagnostics — a 10-year financial audit, a comparison with other high-income countries, and a trawl through the academic literature. We weren’t expecting you to be as fit as a fiddle at 75. But I’m afraid there are some big causes for concern: 

It’s becoming very hard to see you— At the last count almost 7.5 million of us were on a wait list for elective care, you haven’t met your cancer waiting targets in the last 5 years, or your four-hour A&E target in more than a decade. We’re concerned that you’re struggling to manage routine day-to-day activities. 

Your care offering isn’t up to scratch — You’ve always told us to judge you on what you deliver, but you’re being left behind by your peers when it comes to treatable mortality, cancer survival rates and stroke and heart attack outcomes. In short, your vitals are not looking great. 

The population you serve is becoming less healthy— 65% of us are obese or overweight, life expectancy has stalled, and we’re spending more of our years in poor health. Despite your universalist claims, inequalities in health between the richest and poorest are wide and growing. It seems your choices are not serving you well.

You’re becoming very expensive — In 2000, 27% of total day-to-day public service spending went to you. Next year, that number will have climbed to 44%. Spending more on you means spending less on other public services which play a key role in keeping us healthy. I’m afraid this behaviour is not sustainable in the long-run. 


The good news? I can tell you that someone of your age can expect to live for 13 more years on average (to 88) and we have every intention of getting you there (and beyond!). The public want you to succeed — you still make the British people proud — and there’s a lot of work going on to make sure that you are fit for purpose in the long-run. 

But we need to be honest with you, without some serious lifestyle changes, it’s not looking good. Your key vitals are all going in the wrong direction. 

Recommended course of treatment 

For a patient at your age change will be difficult — you’ve developed some bad habits and you can be very set in your ways. But your future health, even survival, depends on you making these fundamental changes, and you now need to get serious about making the adjustments you promised. 

Kick the hospital habit— Just after your 65th birthday, you promised us that you would get on top of your hospital addiction. As you well know, looking after an older population with multiple chronic conditions means focusing on integrated, generalist care in the community, not increasingly specialised hospital medicine. But we’ve seen your bank statements — year-on-year you’re spending more on hospitals, leaving primary and community care fighting for the scraps. If you really want to turn things around, you’ll need to make some hard decisions to redirect spending to where it would be most valuable.

Boost your productivity— becoming more sluggish as you get older is understandable. But at this age, staying productive is more important than ever. You’ve got record numbers of staff (though they aren’t distributed well), a long-term workforce plan and you’ve had some generous funding boosts after the pandemic.

Some tips here: putting more resources on the frontline might not be the best way to improve the situation. All the staff in the world won’t help you if there isn’t enough space for them to work in or they spend half their time logging in to their computers. And growing the number of doctors and nurses but not the administrative and managerial staff that keep the system ticking over is a false economy. Doubling down on the things that really drive productivity is the only way to get out of your current rut. 

Realise you can’t do it all on your own— You aren’t 30 anymore and that means you have to stop trying to solve all your problems on your own. You’ll need some help to achieve your goals — genuine engagement with social care rather than finger pointing over who’s to blame for delayed transfers of care, partnership working with schools to get on top of the crisis in young people’s mental health, and actual partnership with local authorities (no, warm words are not enough).

But sometimes you’ll also have to let go. You’ve got a big role to play to ensure that access to high-quality care is equitable, but given that 80 per cent of health outcomes have nothing to do with what goes on in your four walls, you won’t have much luck trying to transform the health of the nation or get on top of health inequalities on your own. Working out what only you can do, doing it exceptionally well, and devolving power and responsibility to others will make you far healthier and happier. 

We don’t want you to leave this appointment feeling despondent — you’re not the only 75-year-old-facing with a challenging prognosis and you’ve made it through some tight scrapes in the past. Changing your ways will involve swallowing some difficult medicine, but if you’re willing to endure these life-saving changes, we have every confidence that you’ll be in better shape next time we see you.