Summary
The Prime Minister Theresa May has announced a 70th birthday 'present' for the NHS: an extra £20bn a year by 2023, paid for in part by tax rises. It has been received with cries of 'about time' and 'not enough.' Other voices mutter that we are simply pouring good money after bad into a system that is broken. To go with the funding boost, the government has promised a 10-year plan that "tackles waste, reduces bureaucracy and eliminates unacceptable variation," but sceptics say we've seen those promises before. With an ever-aging population and increasing pressures on the system, is it time for a fundamental re-appraisal of the NHS's priorities? What is it actually for? Is the job of the NHS to help us when we get sick, or to keep us from getting sick in the first place? Do expensive treatments need to be rationed, and if so, how should we decide who gets them? The sickest, the youngest, the ones with the best chance of recovery or the ones who can't afford to go private? The mantra of 'free at the point of delivery' embodies a fundamental moral principle that makes the NHS the envy of the world, according to many. Others believe it has turned our healthcare system into a religion - and delivered worse health outcomes than different systems in comparable countries. Ultimately, is it fair to ask those who look after their own health to pay for the treatment of those who don't? Witnesses are James Bartholomew, Dr Brian Fisher, Caroline Abrahams and Dr Kristian Niemietz.
Producer: Dan Tierney.
Transcript
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| 0:00.0 | You're listening to a program from BBC Radio 4. |
| 0:04.3 | Good evening. It seems Hitler was one of the NHS's earliest fans. |
| 0:09.2 | A copy of the beverage report, the blueprint for what was to become the National Health Service, |
| 0:14.0 | was found in his bunker with a scribbled note ordering that if it were to become public, |
| 0:19.4 | Germans should be told it showed how their enemies were taking over Nazi ideas. |
| 0:25.0 | 70 years after its inception, it may be underfunded, but it's certainly not unloved. |
| 0:29.8 | The nearest thing to religion the English have, Nigel Lawson memorably said, |
| 0:34.0 | and to suggest any radical change to the system of universal health care free at the point |
| 0:37.9 | of use is still career suicide for any politician, which is at least odd, given that measured |
| 0:44.4 | by the outcomes for its patients and what other outcomes really matter, it's worse than many, |
| 0:49.7 | sometimes most comparable countries. It's notoriously difficult to make comparisons of this kind, |
| 0:56.0 | but the experts say if you have most forms of cancer, have a heart attack or stroke, your chances |
| 1:00.8 | of survival are lower here than they are in equivalent countries. Infant mortality rates are |
| 1:06.4 | higher, so are your chances of dying unnecessarily in hospital, a hospital like Gosport, war memorial, for instance. |
| 1:13.9 | The NHS costs nearly 10% of our national wealth, with 1.7 million workers. It's by some distance the largest employer in Europe. |
| 1:21.8 | Yet we have proportionately the lowest number of doctors in the EU, and on the same basis, only a third the number of hospital |
| 1:28.1 | beds as Germany. Other countries manage a mix of private and public provision, often with a greater |
| 1:33.5 | role for insurance, without the sick and injured being turned away from hospital for the lack of it. |
| 1:38.7 | The unemployed and the homeless still get treated. The NHS is perhaps the only institution we have |
| 1:44.0 | whose central purpose is |
| 1:45.1 | rarely challenged, and when Theresa May announced this week a birthday present of an extra |
| 1:49.7 | £20 billion for it, a lot of the criticism was that it wasn't enough. Perhaps it's because |
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