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Digital Subscriptions > Prospect Magazine > April 2017 > Back in the emergency room

Back in the emergency room

Since its birth, the NHS has periodically seen off financial crises, charges of unsustainability, and wheezes that would change the basic model. Is this time any different?

Back in 1974, one of my first press conferences as a health reporter was at the British Medical Association (BMA). Such events were then a rarity, although they were soon to become anything but. Shortly after, and for the first time in the history of the National Health Service, hospital consultants were workingto- rule (doing the minimum required by the rules of their contract) over Barbara Castle’s attempt to take private practice out of the NHS—while junior doctors, again for the first time, took industrial action over a new contract. Shades of today, hey?

In a measure of how fast things can change, George Godber, chief medical officer and NHS founding father, had declared in his annual 1972 report that “in time of need for myself or my family, I would now rather take my chance at random in the British National Health Service than in any other service I know.”

Two years on, however, the outgoing Conservative government had slashed spending to cool an over-heating economy, in which—unlike today—inflation was rampant. Like now, the NHS was desperately short of money. It was plagued by strikes from ancillary staff and some nurses over pay differentials. Waiting lists—nobody measured waiting times then—were rocketing. The media had been called to the BMA’s majestic, red-brick Lutyensdesigned headquarters to be told that the service was in crisis.

The press conference was conducted by Derek Stevenson, the BMA’s secretary and a former major in the Royal Army Medical Corps, who combined a cavalry officer’s dash with Rex Harrison’s good looks and a top consultant’s bedside manner. He conducted press conferences in morning dress while chain-smoking his way through untipped Senior Service cigarettes.

Stevenson demanded a £500m cash injection—a monumental sum given that the total NHS budget was only £3bn—and a Royal Commission. He declared that the money had to be found somewhere—from where almost didn’t matter. He came out with ideas for hotel charges in hospital, top-up insurance, charges for GP visits, an extra health stamp, or even a sweepstake. “The fundamental thing,” he thundered, fist crashing down on the table, “is that it cannot go on like this.” In what is now the standard refrain of the NHS, he said that “morale has never been lower.”

For once, it may have been true. But the point of this story is that we have been here before. So, what might happen now, given the view that—despite the huge improvements seen in the first decade of this century—the NHS is once again in deep crisis?

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In Prospect’s April issue: Ross McKibbin, John Curtice and Lisa Nandy examine the state of the Labour Party and question its survival at the next general election. McKibbin takes a long view and suggests that the party’s problems started long before Jeremy Corbyn, Curtice argues that breaking the party is unlikely to go as well as some may think and Nandy argues that tackling unaccountable power could help restore faith in the party. Nicholas Timmins says the NHS has always experienced financial crises so is this time any different? Lucy Wadham charts the rise of France’s Front National. Also in this issue: Owen Hatherley explores Edinburgh’s architectural conundrum, Freya Johnston on Jane Austen and Avi Shlaim on the tragedy of Yitzhak Rabin—the last best hope for peace.