Health: Prof Marcus Longley asks if the NHS is ready for retirement

A doctor
Image caption Rising demand and budget pressures have prompted questions about the survival of the NHS

PROFESSOR MARCUS LONGLEY, director of the Welsh Institute for Health and Social Care at the University of Glamorgan, asks if the model of a national health service introduced in at a time of post-war rationing is still valid in the 21st Century.

The NHS is now older than most of its patients.

It was created in post-war Britain, when we still had rationing, corner shops and nylon stockings. Is it really the best way of providing healthcare in the second decade of the next century, when we are richer than ever before, do our shopping 24/7 online, and have an infinity of hosiery choice?

Are the three cornerstones of comprehensive cover, for all citizens, free at the point of use still applicable, and still attainable?

In other words, should the NHS be looking to retire, like most 64-year-olds?

The case for the prosecution might have three propositions.

First, we citizens have changed, and modern consumers of healthcare don't want monopoly, one-size-fits-all provision.

Second, healthcare itself has moved on, and the range of diseases, treatment options and specialisation demands a new model.

And third, we simply can't afford it any more, not just in the short term (Wales has a looming £0.25bn funding gap), but in the longer term.

Just to cater for more older people, the NHS will need to increase its annual share of national wealth from 8% to 10.2% by the time the NHS reaches the age of 90, but who's voting for higher taxes?

And anyway, if the NHS is good, why have almost no other countries in the world copied it?

The case for the defence might run as follows. First, human beings haven't changed fundamentally in 64 years, and we still think that fairness, compassion and solidarity should shape our healthcare.

The NHS is perfectly designed to deliver these, while also getting better at working in partnership with people. Just look at the opinion polls: the NHS is the most popular institution we have.

Second, while almost every other aspect of healthcare has indeed changed, certain fundamentals haven't.

The NHS is still perfectly designed to deliver these: services dedicated to preventing illness and maintaining good health, distributed according to need (primary care); allied with specialist provision in centres of excellence, equally accessible according to need (secondary care); held together by common bonds of professionalism and shared funding… still sounds pretty good!

And finally, healthcare across the developed world has an insatiable appetite, so every country needs to tackle the growing financial burdens of longevity and self-abuse.

This isn't just a problem for the NHS, but the NHS is best designed to cope with it, being based on providing rational, evidence-based interventions, and ensuring that all sections of society have a stake in its future success.

Why fix something that isn't broken?

If you were a member of the jury, trying the case of the NHS, would you vote guilty as charged, or not guilty?

Marcus Longley is professor of applied health policy and director of the Welsh Institute for Health and Social Care at the University of Glamorgan.

This is a summary of a public lecture to be given at the University Hospital of Wales, Cardiff, on Monday 26 March at 17:30 BST.

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