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Should the NHS retire at 65?

As our health service reaches pensionable age Marilyn Eveleigh reflects on the changes it has seen since the 1940s

On the 5 July 2013 the NHS turned 65 years old. Happy birthday! Is it time for a celebration?

Or should we just acknowledge the date with a fond nod to the brilliant birth of an ideal? The original vision and principle was fantastic and brave and gave security to those without the means to pay for care if they became ill or injured. A contributing insurance fund for all, regardless of class, creed, income or status, that would provide healthcare free at the point of need. What was not to like about it?

Has the NHS lived up to the ambitious vision? The world was very different in 1948. 

What defines 'health' now has changed from 65 years ago. Smoking was a social activity with cigarettes provided to the forces and 'none of the doctor's business' - now it is everybody's business and the health risks are well-recognised. Obesity was rare and physical activity was a normal day-to-day necessity. You had to live with your 'bat ears' - now otoplasty is undertaken to avoid low self-esteem that might impact on mental health. Infertility was whispered about but was 'one of those things' - now it is a health condition and parenthood is seen as a social right. 

We live in a different culture. People were grateful for the care they received but today many expect or demand healthcare for their contributions. Life expectancy was lower and we have achieved more added years but not necessarily a better 'life'. Scientific and technological healthcare advances have changed how we view the world, but we face considerably more moral and ethical dilemmas as a society. Nurses and doctors were well respected, trustworthy and advocates for their patients but recent surveys suggest we would not trust some hospitals with the care of our family or friends. The NHS is now big media bait open to criticism; advocating it as a 'national' service - not an 'international' service - that should care for the sick and not the lifestyle habits of the well.    

Today there are more of us, living in a more multicultural society that is committed to equality and respects diversity. But there are risks that we create populations that reduce their own responsibility for their health. Ask the ambulance service or A&E staff what Friday and Saturday night caseloads are made up of - and it is not the sickness and accidents envisaged by Beveridge when he created the NHS.  

We live longer with higher healthcare dependency but the costs are outstripping the financial input.  My children and I have no concept of what it was to pay for healthcare - but my mother does. If the doctor delivered the baby, he got the fee; if the midwife delivered the babe, she got it. Someone got paid. Interestingly, there is a growing body of thought around that suggests childbirth is not an illness but a condition that should be paid for. Is this OK by you? 

Today evidence indicates that poor health can often be attributed to poor lifestyle choices - should, or can, the NHS continue to pick up the tab? We need to balance the NHS books better and make some uncomfortable decisions. NHS funding is not enough to provide the quantity and quality of healthcare the politicians have promised. Should GPs charge a consulting fee to discourage the huge number of 'did not attends' (DNAs) and the frequent abusers of a primary health service? Can or should we separate social or health needs - what is poor housing, substance abuse or domestic violence? Are continence, hygiene and nutrition social needs that impact on the health of the individual? There are suggestions we should contribute additionally and directly to our consultations, investigations, medicines and hospital meals and laundry - would we be more caring of ourselves if we had to? 

On its 65th birthday, the NHS is unwell and the signs and symptoms are considered endlessly by the great and the good, hoping to establish a diagnosis. It has been worked too hard, with inadequate resources, politically and publically abused. It is physically suffering, mentally tired and socially tarnished. Yes, it is venerated but needs to change with the times to survive. With a worldwide reputation for excellence and accessibility threatened, it needs treatment - and fast. As an employee, taxpayer and user, what is your solution?