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London: The National Health Service (NHS) is famous for being free at the point of need, but analysts say that if the 60-year-old NHS is to serve an ageing and expanding population, the reality of its cost must be accepted.
The anniversary of the NHS, launched on July 5, 1948 by then Labour Health Minister Aneurin Bevan as a cradle-to-grave system, has prompted an avalanche of reviews and studies into its - and the nation's - future health.
Views vary on how to provide the best service for the NHS's 60 million users, but analysts agree on one point: The public and politicians must accept that the cost of the world's largest publicly funded health service is going up, and acknowledge it is a luxury, albeit one this society can afford.
"We have become fixed on the idea that the NHS is somehow free," said David Furness, a health service analyst at the Social Market Foundation think-tank.
"It is not free. We all pay for it through taxation, and it's free at the point of use - that's something quite different. There are no blank cheques, but we should be celebrating the fact that our health system can give so much more than anyone ever imagined it would in 1948."
Europe's largest employer
In terms of sheer size of personnel, only China's People's Liberation Army, America's giant Wal-Mart supermarket chain and India's enormous railway system compare with the NHS.
With a workforce of 1.5 million people across Britain, it is Europe's largest employer, and it deals with eight patients every second. Analysts say a reluctance to recognise the costs of the NHS leads to a lack of realism when it comes to discussing reforms or possible limits on what it can and should provide. The state of the NHS, seen as the crown jewel of Britain's welfare state, is intensely political. Waiting lists for operations, waiting times in emergency rooms, and working conditions for medical staff all pop up regularly as campaigning issues ahead of elections.
During more than a decade in power, Prime Minister Gordon Brown's Labour Party has increased spending on health care dramatically, but his opponents say he and predecessor Tony Blair did not go far enough to change how the system is run.
A major government-commissioned review by Health Minister Ara Darzi, published this week, said the NHS of the future should focus more on the quality of care, not on quantitative targets like cutting waiting times, or waiting lists.
That shift was good news for many in the medical profession. "We welcome the general tenor of Lord Darzi's report that the future emphasis should be on the whole patient/client experience in the NHS - from the quality of the consultants' care to the standard of the food - rather than the crude managerial targets of recent times," said Karen Reay, health officer for trade union Unite.
The review was slammed by the Conservative party, which is riding high in the polls. "The complete lack of vision in these proposals means that, sadly, the government has missed its 'once-in-a-generation opportunity' to enact the real reform that our NHS needs," said Conservative Health Spokesman Andrew Lansley.
challenges
outpaced by innovation
The NHS was founded at a time when massive innovation was occurring, partly prompted by war. The pharmaceutical industry was creating a flood of new drugs. Antibiotics, better anaesthetic agents, cortisone, drugs for the treatment of mental illness such as schizophrenia and depression, good diuretics for heart failure and anti-histamines all became available. These developments, while improving the lot of the patient, raised the cost of the NHS and the government found it had little experience of running a health service with a tendency to expand.
The principles
It was financed almost 100 per cent from central taxation.
Everyone was eligible for care, even people temporarily resident or visiting the country.
People could be referred to any hospital, local or more distant.
Care was entirely free at the point of use, although prescription changes and dental charges were subsequently introduced.
COsts
When the NHS was launched in 1948, it had a budget of £437 million (Dh3,199 million), rising to £9.5 billion 30 years later. The estimated expenditure for 2008-09 is £96.2 billion.
Key facts
The NHS is one of the largest employers in the world, along with the Chinese People's Liberation Army, the Indian railways and the Wal-Mart supermarket chain.
The NHS in England and Wales employs around 1.3 million people. This is approximately one in 23 of the working population. Around 77 per cent of today's NHS workforce is female.
Nurses make up the largest part of the NHS workforce, at just under 30 per cent.
Staff across the NHS are in contact with more than 1.5 million patients and their families on a daily basis.
Approximately 170,000 people (the capacity of the Glastonbury music festival) go for an eyesight test each week.
In 2005/06, the NHS helped to deliver around 16,000 babies at home.
Each month, 23 million people visit their doctor's surgery or a practice nurse.
In a typical week, 1.4 million people will receive help in their home from the NHS.
Full-time GPs, or doctors, treat an average of 255 patients a week.
NHS chiropodists inspect more than 150,000 pairs of feet every week. Seventy-five per cent of women aged 53 to 64 in England are screened for breast cancer at least once every three years.
NHS Direct, a telephone advice line, receives around 20 calls a minute.
There are now around 90 NHS walk-in centres, offering convenient access to services, including treatment for minor illnesses and injuries.
-that NHS budget equates to spending £1,500 for every man, woman and child in the UK. The government has pledged to increase this budget by around 4 per cent in real terms in the coming years - bringing total spending to around £110 billion by 2010/2011.
But the population is getting bigger, and older, with some projections cited by the King's Fund suggesting that by 2066 the NHS's 60 million users will have become 82 million, and more than 25 per cent of them will be over 65 years old.
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