What we have to say Opinion and analysis The NHS at 70 Rachel Power, Chief Executive The NHS celebrates its official seventieth anniversary today. And 'celebrate' is the right word: there can be no doubting the benefit to the nation, and to millions of individual patients, of having a universal, free-at-the-point-of-use health service for the last seven decades. Amid all the justified activity to mark the anniversary, let's not lose sight of one irrefutable, but easy to overlook, conclusion about the NHS: it works. Making healthcare available without charges ensures that the barriers encountered by patients in some other countries are absent here. The gap between the experience a wealthy person has of healthcare and the experience of someone less well-off is smaller than in most countries (though the gap could be reduced further). Where the NHS fares less well in comparison to other countries, the gap is overwhelmingly explained by resource levels – we get out what we put in, more efficiently than most countries manage. Funding the NHS through taxation works to spread the risks of ill health across the population, and is a classic instance of social insurance: everyone pays in, and everyone benefits. True, this model has recently appeared to creak under pressure from political choices. But in truth that's nothing new: while the NHS's trend rate of funding growth may be around 4% over its lifetime, that has come in fits and starts, not at a steady rate. Ways to make the funding growth more even and reliable would be extremely desirable. But nothing is perfect, and the NHS is no exception. The scandal of the failings in care at Mid-Staffs and the recent, awful confirmation of life-shortening clinical decisions over many years at Gosport War Memorial Hospital are two of the most high profile instances where the NHS has let patients down, not merely through mistakes by individuals (which will always be with us), but as an entire system. If there is one reason for optimism, it is that attempts to cover up failures of this sort indefinitely now appear unlikely to succeed and there is an increasing focus on patient safety across the service. Despite this the need for patients to fight for years simply to get the truth is one feature of the NHS that needs to be addressed with urgency. Patients need to be listened to and their concerns heard. But we shouldn't look to the past, good or bad, at the expense of considering the future. The need for the NHS to change, to meet well predicted changes in the pattern of needs among patients, has been known about and talked about for years. Let's not dwell on why work on this transformation didn't start eight, ten, twelve years ago – the creation of NHS England and the publication of the Five Year Forward View finally gave it a meaningful push forward. The new NHS plan due later this year must be the road-map to finishing the job. This must include a focus on investment in community services and primary care to keep people well and independent in their local communities. There must be political support from all quarters for vital changes to ensure the NHS serves patients as they are now and will be in the coming decades, not as they were in 1948. The other trap we mustn't fall into while celebrating the success of the NHS is to mistake it for the sole determinant of people's health and wellbeing. There is far more to health than just the NHS, and no strategy that relies on the NHS alone can possibly hope to succeed. Social care, public health, prevention, support for carers and the welfare benefits system are the obvious other institutional elements. But the determinants of people's health and wellbeing go wider: their socio-economic circumstances, their housing, their work, and their awareness, knowledge and empowerment to look after their own wellbeing are all crucial determinants of the health they enjoy during their lives. That's true for all of us. And there are major challenges looming: there is more to do to reduce smoking; and right now there's no particular reason to think the obesity time bomb won't blow up in our faces. We need to understand that there is a society-wide challenge to steward the nation’s health and wellbeing effectively, and engagement with it at all levels is essential. That should keep us busy for the next 70 years, then.