If we want the NHS to be capable of more, we need to move past our patriotic loyalty and expect more.

A friend once told me that when she was on exchange in England during university she was unwell and went to see the local National Health Service (NHS) doctor. After being met with little help, she asked whether there were any tests that could be run to investigate what was going on with her (usually healthy) body. Laughing, the doctor replied, ‘This is a free healthcare system. Lower your standards’. 

Fast forward five years to when I was having my own daily health issues during my first year of living in London and was struggling with the wait times for testing. Relaying my disappointing experiences with the NHS to my British co-workers, I was largely met with prickliness; ‘You know it’s the oldest public healthcare system in the world, right?’ ‘At least we’re not in America. It could be a lot worse.’

Stunned and embarrassed, I remember registering that I’d touched some nerves and that perhaps criticism of the NHS was off-limits. This has proven true as the years have passed and I’ve continued to encounter friends’ personal anecdotes of occasions in which their care has been fine, and time and again that same shining credential that we are ‘not in America’.

But whilst we can be proud of the majority of hard-working people within it, can we really be proud of the service? Its institutional failings are, as we know, unending; 25% of people report waiting times as having a significant impact on their mental health; 20% have had to resort to private healthcare; 25% feel they’ve not been taken seriously by NHS staff, and (as our last blog piece stated) the system is plagued with racial inequality to an extent in which people of colour are more likely to die than white people with the same illnesses.

Frankly, while 77% of Britons claim the NHS makes them ‘proud to be British’, being “free” isn’t enough to make me feel so – nor does it make me think I should lower my standards. As one of the wealthiest countries in the world, the UK doesn’t deserve a trophy; Healthcare is a human right, there are over 30 countries in the world with public healthcare systems and rankings from 2022 placed the United Kingdom as second to last in terms of its performance. 

And we used to be able to have my opinion, where we could openly interrogate this poor performance whilst also advocating for the NHS. When it started in 1948, perspectives of the system were supportive, but unemphatic. In 1976 the Labour Party initiated a Royal Commission into the NHS which invited and received thousands of accounts of the service’s shortcomings from organisations, healthcare workers and members of the general public. This was to feed into widespread, ongoing reform of the service.

So what happened? Somehow, this opportunity for a sustained national mindset of much-needed constructive criticism was quickly superseded in the 80s by the dissemination of a new form of British patriotism, marked by a devout loyalty to the NHS. Once known as the ‘National Health Service’, marketing meant it not only became the familial ‘NHS’, but it became ‘our’ NHS. 

It was and remains much harder to pick-apart or be critical of something which we, as a nation, feel we own or are responsible for, and which is so ingrained in our identity. Any criticism becomes personal, with reflections of the ‘thing’ becoming a reflection of oneself. The British Covid-19 campaign ‘Protect the NHS’ relied on this assumption. 

When the British have also recently been through so much – from the high covid death toll to the fallout from Brexit, the carousel of Conservative Prime Ministers and now the Cost of Living Crisis, one can empathise with not wanting to face what feels like yet another national disappointment. Holding onto a shining image of the NHS (and probably the only palatable form of patriotism for the Left) is much like a balm to soothe the political and economic sores of years gone by. 

The problem though is that this protectiveness and conflation of national identity with the NHS has (as I discovered upon moving to England) disallowed much-needed open critique of the health service. It means we forget that the NHS is composed of public policy, national targets and government funding, rather than simply representing the overworked staff who must be defended from any generalised censure.  

This has dire consequences. Without properly acknowledging to each other the real failings of the NHS, we are existing in a state of collective denial which prevents us from getting angry, expecting more and pressuring our government for major reform. All we are left with is the hollow comfort of remembering, ‘at least we are not in America’, while more and more Britons’ lives are ruined by hospital waiting lists. 

No, we are not in America. We are in the UK and we value not only healthcare which is free, but healthcare which delivers efficiently and doesn’t leave patients feeling isolated and powerless. In the same way that we know we should challenge, be honest with and ask for more of those we love when they’re falling below their potential, we must do the same for the NHS. We must disentangle Britishness from the NHS and turn our unquestioning pride into energy which may productively re-imagine how great the NHS could be.