Today marks the NHS’s 74th birthday

74 years old,

Admitted following multiple falls,

Struggling with increased frailty since catching Covid.

The dream

The NHS was established in 1948 to ensure healthcare was available, free at the point of need, to everyone. In post-war Britain, it was an act of kindness to all citizens healing from the horrors and sacrifice of war. It was an attempt to uncouple financial challenge from physical sickness. Where health choices are not primarily determined by our finances.  



Quite simply, we all get sick sometimes. Illness can strike indiscriminately. Even when we have access to good, free healthcare it can have a devastating impact on our lives. An essential purpose, as relevant today as at its inception.  

The pivotal work on health inequalities by Marmot shows that even the pre-pandemic NHS those people marginalised and most financially vulnerable were more likely to suffer poorer health. How we look after our most vulnerable must be a crucial marker of a well-functioning health system, and indeed society more broadly.

Like thousands of other healthcare workers in the UK, I’ve worked for periods abroad in health systems where direct financial cost of care to patients is a reality. Witnessing the death of children and young people, as well as adults because healthcare bills can’t be paid is soul destroying.  Never a position in which we would want to find ourselves.  

Whether it be as part of the Olympics opening ceremony or clapping for carers, the Jubilee celebration acknowledgement, or understated thank you cards, as a nation the NHS matters to us. We care about what it stands for, as well as what it does for us and our loved ones.  

The reality


Covid19 has left the NHS battered, bruised, and on its knees. The literal meaning of compassion is to suffer with. By any standards, the NHS has shown deep compassion and has suffered, alongside the rest of society. Whether toiling in ‘hot’ wards enshrouded in thick PPE for 13 hour shifts, facing up to an invisible challenge of a new virus, or the devastating loss of life of patients and clinicians alike. At times, it has been bleak.  

We are not out the other side yet. There will be ripples felt for years to come with the impact of extensive waiting lists and Long Covid, amongst countless other challenges. With deliberations about the Autumn Vaccine Programme ongoing, many are trying to muster the energy to tackle another harsh winter.   

Like many unwell 74 year olds the country over, the NHS needs help to heal. The healer needs healing. Without help there is a very real risk that the NHS will falter and fail, and never quite be as strong again. Much more likely than a single, big bang failure, is a constant erosion of standards. A slow fail, a creeping malaise. With every tale of a cancelled operation, a long wait for an ambulance, or an appointment that someone struggles to get with their GP, the foundations of the NHS are chipped away.  

A chasm has emerged between the dream of what we aspire to provide, and the reality of lived experiences of patients and clinicians.  

Health in times of a cost of living crisis

We are in a period of financial strain, with a vast cost of living crisis. 

Health and prosperity of course are closely interlinked. At times during the pandemic, they have been placed conceptually in opposition with each other. Their true relationship though is that of synergy, rather than conflict

When we are well, we are able to make the most of life – be it employment, education or social lives. Conversely, when unwell there is barely a part of our lives that remains untouched and unaffected. 

Day-to-day, my experience as a GP is that a growing number of patients are choosing to ‘go private’. Long waiting times are a frequent driver and, where finances allow, people switch into the private system. While free choice is a crucial part of a health system, to be driven to paying through experiencing inadequacy in the NHS is more like a decision made under duress. 

Long Covid threatens a significant proportion of the workforce, frequently affecting younger groups, involved in both the cash and caring economies. If even a small proportion of people in their thirties and forties are unable to work owing to chronic ill health, wiped out from caring for their children or their ageing parents, we may soon realise their crucial contributions both in the formal and informal economies. 

Rose tinted? Perhaps. But maybe we’ll allow ourselves a little sentimentality. If not on a birthday, then when can we celebrate, reminisce and cast our eyes forward, creating a future of healthcare that we want and deserve

The future – it’s not all doom and gloom

NHS's 74th birthday

We still have an opportunity to influence our future as an NHS. Whether we are able to celebrate its 80th birthday is up to us, as workers both in and around it, and as a nation. Structural reforms like that towards Integrated Care Systems may help, but the solution will probably lie in something much simpler and highly prized – that of rebuilding trust.

Trust, in ourselves, in each other and in the care we provide. It will take time, it will be a compromise and it will be messy. We need to give the trauma of the pandemic space to breathe. Tales of loss, heartbreak and sadness need to be heard and learnt from. Only when they have, can we heal ourselves, and the NHS, and move forward.  

Rebuilding trust will be a slow and essential process. With effort and intention, we can close the gap between the dream and our lived reality of the NHS, such that we have an institution we can once again depend upon and in whose service we are drawn to give our dedication and compassion.

On the 74th birthday of the NHS, let’s appreciate the dedication of over 1 million staff, and the everyday heroes who are helping to heal our NHS by rebuilding trust through every shift and every patient interaction.  

About the author

General Practitioner, Dr Rich Pratt joined Eva Health Technologies as Clinical Director to better explore what a reimagined health record could be. You can read more in his blog, “Why I joined Eva“.


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