MOST British people cherish the NHS. 

However, we must have sensible public discussions about its future.

Perhaps my personal experience will illustrate one aspect of the problem. 

In 1946, when the NHS was founded, the then Minister for Health defined its duty as being ‘to promote the establishment in England and Wales of a comprehensive health service designed to secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness, and for that purpose to provide or secure the effective provision of services in accordance with the following provisions of this Act’.

So, the prevention of illness was enshrined from the outset. 
Nowhere, however, does the Act codify as an aim of the NHS the prevention or ‘cure’ of death.

In January of 2008, I suffered a complete cardiac block; whereby the electrical supply needed to initiate a heartbeat was blocked. 

When I was born in 1952, such an episode would probably have led to my death: end of expenditure for the NHS.

Because it happened in 2008, a small CRD was implanted in my chest: start of expenditure for the NHS. 

I can now continue to enjoy life and the concomitant chronic illnesses which accompany increasing age.

The NHS was founded at a time when we had a naïve concept of illness as a sequence of discrete episodes. 

We were only just starting to become aware of the concept of chronic disease as a constant companion in old age. Instead of cure, our attention has frequently switched to management of a condition.

We must differentiate the need for social care from the need for acute care. 

The NHS was never intended to provide social care: but to “prevent, diagnose, and treat illness”. 

Such an insight would enable those we elect to govern us to look anew at the whole concept for the funding of social care. 

Not even separate insurance arrangements should be ruled out.

MARK DYER
Nynehead