The UK is not an especially piousDeeply religious, following all the codes of the religion. place. Only 28% of people in the country say they believe in God, and just 5% of the population goes to church regularly.¹

But this is not to say they lack devotion. Observers have long joked that the real British national religion is the National Health ServiceThe publicly funded healthcare system in the UK. The NHS was founded in 1948..

Fully 54% of British citizens say the NHS is what makes them most proud to be British, far outstripping British history, culture or democracy.² As far back as surveys go, it has been the top political issue for British voters.³

But just like British churches, the NHS is undergoing a spiritual crisis. Satisfaction with its services is at its lowest ever level, just 24% - a 29-point fall from 2020.⁴

Which is why some politicians are starting to murmur that it may be time to slaughter the sacred cow and fundamentally change the way the NHS operates. A new NHS consultation is due to examine all the options.

Since its foundation in 1948, the key principle of the NHS has been the idea that it is "free at the point of use": in other words, you should never have to pay a hospital or a GPShort for General Practitioner. In the UK, GPs are doctors who provide general health care for people living in certain areas. directly for the healthcare you receive.

Instead, the entire service would be funded from general taxation. Everyone would pay in, and everyone would receive an equal service.

Britain was the first country in the world to adopt such a system, spurred on by memories from the Great DepressionA severe worldwide economic depression that started in the US in 1929. When Roosevelt was elected, the US unemployment rate stood at over 20%. of poverty-stricken people paying their last pennies for a doctor to come and see them in their homes.

But from the very start the NHS ran into financial difficulties, and just three years after it was founded, the Labour government voted to introduce charges for dental care, glasses and prescriptions. The founder of the NHS, Nye BevanAneurin "Nye" Bevan was a Welsh Labour Party politician. He is known for his time as Minister for Health and being chief architect of Britain's National Health Service. , resigned in response.

And private interests continued to creep into the service. Margaret ThatcherBritain's first female prime minister and the longest-serving prime minister of the modern era. introduced an "internal marketIn the NHS, the split between those who provide services, such as hospitals, and those who purchase services from them. ", claiming it would make the service more efficient. Tony BlairTony Blair was the leader of the Labour party. He was British prime minister from 1997 to 2007. 's New Labour government farmed out services in many hospitals to private companies.

Some say this is simply an inevitability. They claim the NHS model is not fit for the 21st Century.

The problem is this: the NHS is funded through taxes, but the bulk of its care is given to retired people who, because they do not work, do not pay taxes. And this section of the population is getting larger. 

When the NHS was founded, every 100 people in work only had to support 14 people who were not working and paying taxes. It is estimated that by 2050 those 100 workers will have to support 53 retired people. They say this means the taxation model is unsustainable. 

The new government may come to the same conclusion. The new health secretary, Wes Streeting, has rejected "top-up fees" for services, but some fear his new plan to start sharing patient data with the private sector will allow private companies to profit at the expense of the health service.

Others point out the public does not want wholesale reform. Surveys show British voters are terrified of ending up with a US-style system where people sometimes have to pay directly for their own healthcare. Some 34 million Americans say a friend or family member has died because they could not afford medical treatment.⁵

NHS "reforms", they say, have generally been unpopular and made the service worse. They claim the choice is simple: raise more money to fund it, or let people die.

Is free healthcare impossible?

Yes: We cannot have a service used mostly by one-third of the population but entirely funded by the other two-thirds. It was a good idea once but we cannot sustain it in the present.

No: We get the service we pay for. We just have to accept that if we want a free and equitable healthcare system then we will have to pay more tax to keep it running.

Or... The NHS crisis is part of a broader downward spiral: the economy is barely growing, so people have less money, so they pay less tax, so the government has less money to spend on services, so there is less growth. We have to break the cycle.

Pious - Deeply religious, following all the codes of the religion.

National Health Service - The publicly funded healthcare system in the UK. The NHS was founded in 1948.

GP - Short for General Practitioner. In the UK, GPs are doctors who provide general health care for people living in certain areas.

Great Depression - A severe worldwide economic depression that started in the US in 1929. When Roosevelt was elected, the US unemployment rate stood at over 20%.

Nye Bevan - Aneurin "Nye" Bevan was a Welsh Labour Party politician. He is known for his time as Minister for Health and being chief architect of Britain's National Health Service.

Margaret Thatcher - Britain's first female prime minister and the longest-serving prime minister of the modern era.

Internal market - In the NHS, the split between those who provide services, such as hospitals, and those who purchase services from them.

Tony Blair - Tony Blair was the leader of the Labour party. He was British prime minister from 1997 to 2007.