The 5th of July marked yet another birthday for the NHS. There was a ceremony at Westminster Abbey to celebrate and thousands turned out to pay homage on its seventieth birthday. Tributes poured in throughout the day. Simon Stevens, NHS England chief executive declared it a “unifying ideal”. Another, an NHS surgeon described it as “…a grand lady who watches over us every day” and Conservative MP Guy Opperman explained the “incredible debt” he owed to the service for the life-saving treatment with which it had provided him.
Whilst it has undoubtedly been the case for several years, the NHS appears to be something of a sacred cow within the realm of British political discourse. It’s the closest thing we have to a state-sponsored religion and this reveals itself in the way we talk about and relate ourselves to it. Whilst the tributes given on the 5th of July are very endearing it is slightly concerning that one could quite easily have mistaken much of this language as overtly religious. We’ve become personally invested in the NHS to the extent it now forms a part of our national identity. Repeatedly we are told by those from all parties that this central pillar of British life is a national treasure that desperately requires ‘protecting’. What exactly this means is unclear. However, this pseudo-religious power the NHS holds over our entire political class is by no means an aid to its continual improvement. Few would contend that the NHS is perfect, or even as good as it could be, so there is by all accounts, room for change and development.
But this is a reality that needs to be reflected in how we talk about the health service. At present we speak of it as if it were a divinely inspired miracle. Our reverence for the NHS is obstructing an honest conversation about its sustainability. Self-indulgence has generated an aversion to change for fear it may damage this most sacred institution. Everybody should want to change the NHS precisely because we know it can be so much better. Merely to admit that there are noteworthy problems at all is to say that there must be some significant change. Yet conversation on this topic has become increasingly difficult. Efforts or suggestions to reshape or modify the NHS are often viewed as an attack on this hallowed institution influenced by narrow cynicism and self-interest.
Is it conceivable that the NHS could benefit from compromising on its principles or structure? May there may be something to be gained from deviating from our current restraints? It seems self-evident that there may be benefits that require us to make such a compromise. However, we will remain unaware of these solutions in perpetuity if the political penalty for discussing them remains so high. Could there be net benefits from making compromises on the hallowed,‘free at the point of use’ or other core principles? The truth is we don’t know, but these questions have an answer and we need to be able to talk about these possibilities freely.
Nonetheless, the untouchable status of the NHS in the political conscience makes mere conversation or research into such questions political suicide. Any significant adjustment at all is often viewed as negative by default. Not necessarily because they would deliver poor consequences, but because we are so emotionally invested in the NHS that alterations make us feel uneasy. To languish in this fragile state is not only obstructive but also a form of moral confusion. The only variable of importance when making alterations to the health service is how said changes will improve the well-being of the British people. Success and failure should be judged only against this standard. If emotional concerns about altering an esteemed British institution make one unwilling to entertain a conversation about restructuring the NHS then they are simply morally confused.
To this end, sentimentality has scrambled our senses with regard to success and failure. Deviating from the NHS’s traditional principles may bring benefits and we have to be free to talk about these options without social cost. Change will not always be in zero-sum conflict with quality of care. It will always be in conflict with the status quo. There may be benefits for which we must sacrifice nothing. But if reform in and of itself is deemed a penalty then we will never be in a position to take advantage of such opportunities. This is, of course, assuming that we can even summon the stoicism to research and discover such possibilities in the first place. The stakes are high. Time is ticking. We don’t have time for perennial self-indulgence.