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What went wrong with Britain's National Health Service


Britain's National Health Service is living through what some see as the worst crisis in its history. It's plagued by staff shortages and record-breaking delays. Junior doctors this week started a three-day strike - the latest in a wave of protests by health workers. All of this is fueling debate about the future of Britain's system of free universal health care. NPR's Philip Reeves reports.


PHILIP REEVES, BYLINE: Jenni Hudson is an ambulance paramedic in the west of England. She joined the service a decade ago because of something that happened in her childhood.

JENNI HUDSON: When I was about 15, I had a seizure, and the paramedics who treated me were absolutely fantastic. And it just made me realize that I wanted to do something that would make a difference to people and would help people.

REEVES: Hudson's finding it difficult to make a difference these days because of the crisis gripping Britain's National Health Service or NHS.

HUDSON: It's heartbreaking. This is not why I joined this job.


REEVES: We meet on a picket line on a recent, cold and blustery day outside the city of Bristol. Ambulance workers were holding a one-day strike over pay, but Hudson's here for other reasons.

HUDSON: For me personally, it's more about just really bringing to light the state of the NHS.

REEVES: This winter, Hudson watched a tragedy unfold. Hospitals were jammed. That's partly because some patients, although well enough to be discharged, couldn't be released because of a lack of community care. Long lines of ambulances carrying incoming patients formed outside hospitals, sometimes waiting for up to 14 hours, she says.

HUDSON: It means that, you know, whilst ever we're sat waiting with that patient, there are other patients in the community who have got nobody to help them, and people are dying waiting for us.

REEVES: This is far from what the British had in mind when they created the NHS back in 1948. Britain was still digging out from under the wreckage of the Second World War when Prime Minister Clement Attlee made this speech.


CLEMENT ATTLEE: Tomorrow, there will come into operation the most comprehensive system of social security ever introduced into any country.

REEVES: These were the most radical social changes in modern British history.


ATTLEE: The scheme gives a complete cover for health by pooling the nation's resources and paying the bill collectively. It's not dependent on insurance. Everyone is eligible.

ROBERTA BIVINS: It was regarded as astonishing, and the place where it was regarded as absolutely the most astonishing was the United States.

REEVES: Professor Roberta Bivins is an expert in the history of Britain's National Health Service.

BIVINS: In fact, it was seen as something quite fearsome and terrifying or, alternately, as a great experiment.

REEVES: Bivins is originally from the United States, but she's based at the University of Warwick in England and is now a British citizen. She remembers her first visit to a British family doctor years ago. She tried to pay. The doctor waved away her money. Bivins found this...

BIVINS: ...Mind-blowing. The word is mind-blowing, and my mind was blown.

REEVES: Bivins says Attlee and his leftist Labour government were on a mission to create a far healthier population.

BIVINS: There was a real belief that investing in health was investing in prosperity and also that if you address the causes of ill health that you would eventually get rid of the need for a full-on national health service.

REEVES: Seventy-five years on, Britain's National Health Service is more full-on than ever. As for prosperity...

OLGA LEACH-WALTERS: There are a lot of NHS workers who are actually now dependent on food banks.

BIVINS: Olga Leach-Walters is a nurse and a union official. She says nurses are struggling with low pay, surging living costs and staff shortages. In England, there are more than 40,000 vacancies for registered nurses. She worries about the future.

LEACH-WALTERS: We need our NHS. This is something that we love, we adore. The NHS is like - you know, it's like Buckingham Palace.


REEVES: That love was on full view in the COVID pandemic. Britons stood on their doorsteps applauding an institution that many revere as the embodiment of national values. Most want to keep it says Max Warner of the Institute for Fiscal Studies in London.

MAX WARNER: I think the key fundamentals of care that's free at the point of use and funded by general taxation is one that's very popular among the British public.

REEVES: That's despite the huge bite it takes out of the national budget.

WARNER: It's by far the biggest public service - much larger, for example, than education or defense.

REEVES: Roughly 10% of Britain's GDP goes on health. That's less than France, Germany and the U.S. says Warner. Britain's real-terms health spending actually goes up every year, but under the last decade of Conservative government, the rate of increase went down. There's growing pressure on the system.

WARNER: It's a really serious crisis at the moment. And part of what makes it so difficult to talk about and understand is there's pressures from all different parts of the system, and then they feed into different parts.

REEVES: Those parts include some of Britain's most far-flung areas.


REEVES: This is Lostwithiel, a small country town in Cornwall on Britain's southwestern tip. It has a salmon river, a couple of pubs, a 12th century church and a ruined medieval castle. Justin Hendriksz has been the local doctor here for 16 years.


REEVES: He's sitting in a cafe. Like Doc Martin, he knows almost everyone.

JUSTIN HENDRIKSZ: I get to know families. I see babies being born. I see elderly grandmothers. You know, you walk in somewhere, and they say, hi, doc, how are you? You know, thanks for seeing my dad last night.

REEVES: Hendriksz works with one other family doctor. That doctor's retiring, so Hendriksz advertised for a replacement. No one applied. Hendriksz says England doesn't have enough doctors.

HENDRIKSZ: Because of pressure, because of more paperwork, less time with your patient, more rules....

REEVES: Some are retiring early, he says. Others are leaving for better paid jobs overseas.

HENDRIKSZ: It absolutely breaks my heart, and I - at this point, I don't know how it's going to be better.

EMMA MANSFIELD: Because I run the community choir here, I quite like rewriting the lyrics to well-known songs or writing silly songs.

REEVES: That's Emma Mansfield. Desperate to lure a doctor to town, Hendriksz asked her to make a video literally singing its praises.

MANSFIELD: So we went through all of the different songs that were related to health or doctors that would be familiar. And then we found Nina Simone's "Ain't Got No, I've Got Life."

(Singing) We've got a river and a beach. We hold events amongst the trees.

REEVES: Hundreds of locals - firefighters, butchers, bakers - joined in.


UNIDENTIFIED GROUP: (Singing) It's a special place to live. If to us you want to give, you can negotiate your terms. If you'll keep us free of germs, drop us a line.

REEVES: The town may now find its doctor, but the country's problems are more fundamental than that. Britons are getting older. Diabetes, dementia and obesity are rising. Roberta Bivins, that professor whose mind was blown by the NHS, thinks it's time to return to the vision of its founders in 1948.

BIVINS: ...Which said your exchange, British people, for getting health care that's free at the point of need is that you have to help yourselves be healthy.

REEVES: Some on the political right say tax-funded universal health care is unsustainable. Many Britons fear there are plans to privatize it. That's easier said than done in a country that loves its health service but not its politicians. Philip Reeves, NPR News, Lostwithiel, England. Transcript provided by NPR, Copyright NPR.

NPR transcripts are created on a rush deadline by an NPR contractor. This text may not be in its final form and may be updated or revised in the future. Accuracy and availability may vary. The authoritative record of NPR’s programming is the audio record.

Philip Reeves is an award-winning international correspondent covering South America. Previously, he served as NPR's correspondent covering Pakistan, Afghanistan, and India.

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