Health service shows its age as it turns 75

Financial crash

"In the period between 2010 and 2015, when there was a coalition government, we were dealing with the consequences of the financial crash under the previous government in 2008. And difficult decisions had to be taken in that period."

The challenges posed by an aging population meant the NHS would have to evolve into being more about prevention than just cure, he said. "One in four of the British public now have two or more conditions, and that's why we're focused through our major conditions strategy, looking at treating people more holistically."

The Conservative prime ministers Margaret Thatcher and David Cameron both pledged that the NHS was "safe in our hands", but the incumbent Rishi Sunak, the richest ever British prime minister, has been put in an awkward position over his use of private healthcare, and with disputes over pay, and the lingering whiff of privatization in the air, widespread skepticism remains over how much the Conservatives genuinely care for the NHS.

The NHS is facing what is being described as its longest-ever strike as tens of thousands of doctors in England launched a five-day walkout over pay on Thursday.

The British Medical Association, the doctors' union, has asked for a 35 percent pay rise to bring junior doctors' pay back to 2008 levels once inflation is taken into account.

The workload of England's 75,000 or so junior doctors has swelled as patient waiting lists for treatment are at record highs in the wake of the pandemic.

"Today marks the start of the longest single walkout by doctors in the NHS's history, but this is still not a record that needs to go into the history books," the association's leaders Robert Laurenson and Vivek Trivedi said.

They urged the government to drop its "nonsensical precondition" of not negotiating while strikes are in progress.

The government said it had accepted recommendations from independent pay review bodies for salary increases of between 5 percent and 7 percent in the public sector.

With a general election due by the end of next year, this would seem to be handing the opposition Labour Party a gift by taking up the position of defender of the NHS, something it has been keen to do.

"The Conservative Party that's brought (the NHS) to its knees will put it in the ground," Labour leader Keir Starmer said in a recent speech. "But mark my words, if all we do in the Labour Party is place the NHS on a pedestal and leave it there, that's not good enough either."

Reform was needed, he said, setting out plans for "serious, deep, long-term changes … a move from an analog to a digital NHS. A tomorrow service, not just a today service".

However, even those most likely to welcome such positive talk want to see more details before embracing the proposals.

"We need to see specifics on what a boost to funding would look like," said Matthew Taylor, chief executive of the umbrella group the NHS Confederation, adding that "we need to understand how Labour would achieve, and fund, such a move", when talking about changes to social care.

Nigel Edwards, chief executive of the think tank the Nuffield Trust, called the plans "welcome but extremely ambitious" and warned that delivery would need "time, staff and more long-term funding than Labour have so far pledged".

Industrial action

Members of the Royal College of Nursing recently took their first-ever industrial action, providing a barometer of feelings within the sector, and pay disputes involving ambulance drivers and junior doctors are unresolved.

This month the newspaper The Observer reported that nearly 170,000 workers left NHS jobs in England last year, a record-high turnover, with more than 41,000 nurses quitting.

Post-pandemic exhaustion was cited as having driven many out of an already overfished pool of talent, and it is not just the number of personnel that is a cause for concern, but the cumulative loss of experience that is putting further strain on the NHS.

"Staff did brilliant work during the pandemic, but there has been no respite," said Julian Hartley, chief executive of NHS Providers. "The data on people leaving is worrying, and we need to see it reversed. We need to focus on staff well-being and continued professional development, showing the employers really do care about their front-line teams."

As the spontaneous public response during the pandemic showed, the British people — and, crucially at this time, the British electorate — love the NHS, and some observers may say almost too much, meaning that it can never be seriously questioned.

But whoever next governs Britain, and whatever happens before the decision is taken on who that is, the fact that the NHS needs help summoning up the puff to blow out its own birthday candles should be a warning to everyone that awkward questions, and potentially difficult realities, remain to be confronted.

Agencies contributed to this story.