The NHS: evolution or dissolution?

Abstract

That could have been written in the United Kingdom in 1988 at the time of writing this chapter; yet it was written in the United States of America in 1977. It is hard to get a sense of perspective about the perceived and real state of crisis in the National Health Service (NHS) today in order to measure the problems and difficulties, especially the shortage of resources, against the very real achievements and progress. The NHS is often described as a wallowing bureaucracy, sucking in resources without real accountability. The figures of rising costs and increasing staff flow from politicians’ mouths and journalists’ pens. NHS staff numbers have doubled since 1948, increased by over 600000 in the past two decades. Can we demonstrate a better health service as a result, or are we just employing more people? These types of questions are being asked in more or less rational ways by many people.

Colleges, hospitals and universities have grown larger than an earlier generation would have dreamed possible. Their budgets have grown even faster, yet everywhere they are in crisis. A generation or two ago their performance was taken for granted, today they are attacked on all sides for lack of performance.

Drucker (1977)