We all love the NHS, don’t we? Despite the ubiquity of platitudes about defending ‘our’ NHS, though, exactly what we are defending and why?

The NHS has undergone significant changes in the 67 years since its inception. Shifts within patient demographics, combined with increased patient demands and advances in technology and medical care, have resulted in a system at breaking point. One million patients are seen every 24 hours, at a cost of £2 billion each week. The kind of care available and sums of money involved would surely astonish the institution’s founders. Indeed, although often perceived as one homogenous care provider, high-profile scandals, such as those at Mid Staffordshire and at the Morecambe Bay Maternity Unit, have illustrated the variability in care across different hospitals – even within the same trust. And on many important measures – for example, cancer survival rates – the NHS seems to perform badly compared to health services in comparable countries. 

Nevertheless, the NHS is one of the few manifestations of the British state that elicits strong and often positive feelings from significant numbers of people. Politicians and parties often define themselves in relation to the NHS and compete to be seen to be supporting it – even when this can be difficult to reconcile with their policies and track record. No major party seems willing to have a more fundamental discussion about whether a taxpayer-funded health service, governed by national and local government, is the best way to take care of the nation’s health.

Yet, at the same time, the reality is that more and more publicly funded healthcare is provided by profit-making or third-sector organisations. The introduction of the Health and Social Care Act 2012, particularly in relation to the commissioning of services from ‘any willing provider’, has opened the doors to private and volunteer input, often with variable results. Following the Conservatives’ victory in the 2015 general election, many supporters of the NHS fear that these reforms will be pursued further. 

Yet is the NHS everyone queues up to defend more national myth than effective health care? Can it survive in its current form, and more importantly, should it?