Comment Blog 22 September, 2022

Thérèse Coffey should remember Bevan, but his NHS model needs a rethink

Charlotte Pickles

‘I shudder to think of the ceaseless cascade of medicine which is pouring down British throats.” In these words, Nye Bevan, founder of the NHS, foresaw its greatest threat: self-perpetuating demand.

For a nation traumatised by war, the NHS represented the hope of a better future. The principle of a universal service, free to all at the point of use, was inspiring — part of a postwar social settlement befitting a generation who had sacrificed so much.

Yet those infamous words were uttered little more than a year after the NHS’s inception, and not long after, Bevan resigned in protest at the first curtailment of that inspiring principle (charges for dentures and spectacles).

Fast forward three quarters of a century and we have a far more pernicious form of rationing: delays to care. This is not intentional, clearly it is roundly decried by health professionals and politicians alike, but it is an indisputable fact: 6.8 million people are on waiting lists for care, only about half of people report being able to make a GP appointment when they want one, and when it comes to social care and mental health support, millions are missing out on care due to high access thresholds.

We’re still pouring drugs down people’s throats — and money into the NHS budget — but no one would claim that meets Bevan’s vision. The public certainly don’t think so, satisfaction with the NHS stands at a mere 36 per cent.

An urgent rethink is needed, which is exactly what ten former health ministers — from across the political spectrum — are calling for in a letter organised by Reform and published in today’s Times. As they say, “our hospital-centric model is no longer fit for purpose”. How to change this is the focus of Reform’s new research programme.

The NHS was designed to provide episodic care to a population few of whom lived beyond 65. Most of the conditions that dominate healthcare spend today were rare or little recognised. Unsurprisingly, a service designed for a different era is buckling under the rising demand of today’s increasingly elderly and unhealthy population.

The NHS itself, and successive health secretaries, have recognised this. For two decades the ambition has been to shift care from hospitals to homes. Yet this commitment to more preventative, less crisis, care has not materialised — hospital spending as a share of all health spending has been increasing since 2015.

Between 2010 and 2020, the hospital consultant workforce grew by 45 per cent, while the number of community nurses and health visitors decreased. Our obsession with hospitals is driving demand, and with it the NHS’s decline. In dedicating more public money to the acute, we’re dedicating less to services that tackle the causes of ill health.

Thérèse Coffey should remember Bevan’s words as she shapes her vision for health and care. We need fewer pills and more prevention. The NHS cannot be the default fixer of all ills. We’re told this government is more interested in outcomes than popularity. It would be a truly transformative health secretary who recognises that saving the NHS means reimagining this postwar model.

This article originally appeared in The Times' Red Box, on 22 September 2022.