Why the NHS is a modern wonder of the world

For the United States, 4 July is one of the proudest days to be alive. A day of national acclamation and revelry. A true and largely sincere celebration of history.

For the United Kingdom, 5 July should be the same. It is, after all, in the words of historian Peter Hennessy, "one of the great days in British history. A day that transformed like no other before or since the lives and life chances of the British people."

He's talking about the founding of the National Health Service, which took place on 5 July 1948.

And he's right. There's no reason why, the next time a politician launches yet another campaign for a new national holiday, 5 July ought not to be at the top of the shortlist.

Triumphant example

For the NHS is one of the wonders of the modern world. If it didn't exist, not only would we be a far more ailing and avaricious society, there would also be no chance of it ever existing.

As observed by Aneurin Bevan (pictured), the Labour minister who shepherded it into existence, "a free Health Service is a triumphant example of the superiority of collective action and public initiative applied to a segment of society where commercial principles are seen at their worst."

You would never hear a politician speak or think like that now.

It was a miracle that it was born, and it's a miracle it's still here.

It took 40 years of lobbying, protest, planning and argument to get it up and running. The British Medical Association opposed its creation (initially proclaiming "it looks uncommonly like the first step towards National Socialism [aka fascism] as practised in Germany") just as they opposed Margaret Thatcher's introduction of a managerial culture into the NHS 40 years later.

Tony Blair came to power in 1997 promising to scrap the manager-led 'internal market', which he did, then he changed his mind and brought it back.

Now the Tory-Lib Dem coalition government is pushing through changes to the NHS in England that will see increased competition, hospital closures, and the privatisation of certain services.

Many medical associations oppose the changes, and years of uncertainty and upheaval lie ahead. But still the NHS survives.

Hidden from view

Why, then, is it not more publicly celebrated?

Perhaps because, even though the NHS is all around us, it's also hidden from view. You don't realise how exceptional it is until you use it, which for a lot of the population is hardly ever.

Opinion polls regularly affirm our enthusiasm for the principle of the NHS, but not always (literally) its practice. And as historian Paul Addison noted, "However genuine, [the public's] appreciation is limited in one respect. Much as they value the NHS, they do not remember what the health services were like before it started."

Moreover, positive stories about the NHS (i.e. patient has successful kidney transplant) are rarely reported. Instead, headlines tend to scream of this or that instance of medical malpractice, or surgery gone wrong, or a patient who came out of hospital worse than when they went in.

Sure, things will sometimes go wrong. But then the NHS is the fifth largest employer in the world, after the Chinese Army, Indian Railways, Wal-Mart and the US Department of Defence.

If you're still not convinced, consider Rudyard Kipling's famous phrase: "What do they know of England, who only England know?" Nobody can truly appreciate the character of the land in which they live until they leave it. In other words, you can't truly appreciate the glory of the NHS until you've been somewhere where it doesn't exist.

Somewhere like the United States, which spends more of its GDP on health than any other nation in the world, yet is the only wealthy, industrialised country without a universal health care system and has almost 50 million people unable to afford any health insurance whatsoever.

Somewhere like Sweden, where the state pays for around 85% of all medical costs and even reimburses patients the cost of travelling to and from a hospital, but where waiting times are considered scandalously long, and can vary depending on the region of the country in which you live.

Somewhere like Cuba, where a free health service is written into the constitution and where standards outrank North America, but where citizens live in a one-party state under a creaking dictatorship.

Nakedly altruistic

There's simply nowhere else that has dared to create something like the NHS. Its motto is surely one of the most shamelessly altruistic ever coined:

"The NHS is committed to providing quality care that meets the needs of everyone, is free at the point of need, and is based on a patient's clinical need, not their ability to pay. The NHS will not exclude people because of their health status or ability to pay."

In an age where politicians give the impression of knowing the cost of everything but the value of nothing, and where people of all persuasion shrug off responsibility for the price of a tank of petrol or loaf of bread, there's something profoundly reassuring about those words.

Peter Hennessy again: "5 July 1948 was the second of Britain's finest hours in the brave and high-minded 1940s. Like the Battle of Britain it was a statement of intent, a symbol of hope in a formidable, self-confident nation… The NHS was and remains one of the finest institutions ever built by anybody anywhere."

I wouldn't want to fall ill in any other country in the world.

(This article was first published on 2 July 2008)