Looking back over the past 60 years reminds us of some familiar debates in the NHS: concerns about financial sustainability, wastefulness, and rationing of resources are all familiar issues today.
But life, health and the new post-war NHS was very different in 1948. In 1946 the government noted that although deaths from diphtheria were falling, “it is a sad reflection that in this country during the war far more children under 15 were killed by this preventable disease than by enemy bombs”. But mortality from infectious diseases continued to fall and in 1951 the minister of health was able to reflect on the previous 50 years as a “brilliant picture of progress”.
But anticipating demands on the new NHS was tricky. The Guillebaud committee, reporting in 1956 on NHS costs, demonstrated Niels Bohr’s famous maxim that prediction is very difficult, especially about the future. The committee thought the high marriage rate would continue, and reported: “Among the group of old people who make the largest demands for inpatient care (single men and women) there is not likely to be any material increase in the population at risk during the next 25 years.”
So, what might the NHS look like 60 years hence? A presumption is that it will still exist. Disaster aside, there seems no reason not to presume that public support for the NHS will not continue. But while the ideals of collective funding according to ability to pay and free and equitable access based on need may survive, organisationally, as we know from historical experience, the NHS may look very different.
One difference could be the divestment by the state of much of its ownership of hospitals except where it makes better sense for health. Politically, it is difficult: nonetheless, a new mixed ownership of competitive healthcare providers is arguably the logical conclusion of current trends.
By 2068, the NHS will be serving a population of over 80 million, a quarter of them over 65 (see first chart). Complete economic collapse aside, they will be much wealthier on average - real GDP per capita may have doubled - and healthier than now. Mortality rates may not be zero as the crude time series projections might suggest (see second chart), but there will be significant reductions.
As for NHS spending, historic trends and the fact that as countries get wealthier they tend to devote a higher proportion of their wealth to healthcare suggests that in 60 years the NHS could consume 16-20 per cent of GDP (see bottom chart) and double the number of its employees to over 2.6 million.
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