Junior doctors and members of the British Medical Association stand on a picket line outside Leeds General Infirmary at the start of a five-day strike amid the dispute over pay, the longest walkout of its kind in the history of the NHS, in Leeds, England, on July 13, 2023. (PHOTO / AP)

Editor's note: As Britain's National Health Service marks 75 years of existence, China Daily takes a look at its history, its practices and the tough challenges it faces.

Few opportunities or responsibilities are given to a city as big as hosting the Olympic Games.

With much of the world watching, and waiting four years for the big event, the pressure on a host to get things right is enormous — but it is also a once-in-a-generation opportunity to showcase the country, how it sees itself and what it is proud of.

At the opening ceremony for the Games in London in 2012 Britain produced a dazzling piece of imaginative, witty and self-deprecating public theater, highlighting elements of its national story such as the Industrial Revolution, its rich tradition of children's literature, cutting-edge pop culture — and, no doubt to the bemusement of many of the hundreds of millions around the world watching, the National Health Service, or NHS.

The inclusion of a dance sequence inspired by a national healthcare provider in such a spectacle may have seemed bizarre to many, but it demonstrated the importance of the cradle-to-the-grave, free-at-the-point-of-use system, and its centrality to the British national identity.

The foundational document of the NHS on July 5, 1948, said: "It will provide you with all medical, dental and nursing care. Everyone — rich or poor, man, woman or child — can use it or any part of it. There are no charges, except for a few special items. There are no insurance qualifications. But it is not a 'charity'. You are all paying for it, mainly as taxpayers, and it will relieve your money worries in time of illness."

Just to underline the national reverence for the NHS, its 75th anniversary was marked with a commemorative service at Westminster Abbey, the setting for the funeral of Queen Elizabeth and the coronation of King Charles. The abbey also provided one of the most infamous images of the European Union referendum campaign of 2016: Boris Johnson standing in front of a bus bearing a slogan about sending money to the NHS rather than to Brussels as if that were the ultimate act of goodness. Seven years later it has yet to be fulfilled.

The National Health Service is treated like a revered, aging family member, but as it passes such a significant milestone, the health of the healthcare system is causing more concern than ever, and its condition is critical

The NHS is treated like a revered, aging family member, but as it passes such a significant milestone, the health of the healthcare system is causing more concern than ever, and its condition is critical.

Booking an appointment to see a doctor at a local surgery has become increasingly difficult, putting many people off even trying. During the pandemic, services were put to the test as never before, and long-running disputes over funding and pay for staff have led to services being overstretched with morale reaching rock bottom, culminating in bouts of strike action involving paramedics, junior doctors and nurses.

To more commercially minded people the reliance of so many people on a free-at-the-point-of-use service means a huge moneymaking opportunity is going begging. The specter of future NHS privatization haunts the British public like the third ghost in A Christmas Carol by Charles Dickens.

The British government has become increasingly obsessed with reducing immigration. According to figures published by Parliament last year, about 16.5 percent of NHS staff are non-British, with more than 200 nationalities represented in the workforce — another red rag to some politicians.

Reliance on overseas staff is nothing new. In 1961 the president of the General Medical Council, Henry Cohen, told the House of Lords: "The Health Service would have collapsed if it had not been for the enormous influx from junior doctors from such countries as India and Pakistan."

Writing in the BMJ, the British medical journal, on the NHS's 75th birthday, David Oliver, an NHS doctor of 34 years, said the service faced "an existential crisis as bad as at any time since (it) was founded".

"We have more than 7 million people on waiting lists for elective care, millions more probably missing from them, and the worst waiting times for decades.

"We have among the fewest hospital and intensive care beds per capita in the OECD, hospitals routinely running at full and unsafe bed occupancy, handover delays, overcrowding in acute care, and many acute beds occupied by people fit to leave but waiting for community services that don't have the capacity, funding or staff."

Without immediate action, he said, the NHS is unlikely to be around to celebrate its 85th birthday.

In the Health and Social Care Act of 2012, introduced by the coalition government on the watch of the then-health secretary Andrew Lansley, choice and competition were promoted in importance as a way the NHS should be run, which critics would say opened the door to the privatization of services.

In June last year, a study by the University of Oxford published in the Lancet Public Health journal said, "The privatization of the NHS in England, through the outsourcing of services to for-profit companies consistently increased (after 2012)."

This came at the highest price possible, the study said. "Private-sector outsourcing corresponded with significantly increased rates of treatable mortality, potentially as a result of a decline in the quality of healthcare services."

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A report published by the healthcare charity the King's Fund in April said the NHS had "declined since 2010, as a result of much lower funding increases, limited funds for capital investment and neglect of workforce planning".

However, in an interview with Sky News, Health Secretary Steve Barclay defended the government's handling of the NHS. 

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 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.

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"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.