The UK’s pioneering health service is facing a raft of challenges as it enters its seventh decade.
When planning the opening ceremony for the 2012 Olympic Games, director Danny Boyle was tasked with choosing themes that would best sum up the UK.
Some were obvious: the Queen, the Beatles, James Bond, but others less so, at least from outside.
A chain of nurses encircling the main stage, bustling around children who jumped up and down on their hospital beds symbolised the country’s National Health Service (NHS).
While the Olympics might have seemed a strange place to celebrate a government body, a national poll conducted at the 2012 games ranked the NHS as the institution that made people “most proud to be British”.
In the 70 years since its founding, the NHS, with its core value of free healthcare for all at the point of delivery, has become not only an intrinsic part of British life, but also an inspiration around the world.
But, as it struggles to cope with funding cuts and an ageing population, the future of the service, and its international reputation is uncertain.
Winters of discontent
On Wednesday, NHS England took the unprecedented step of suspending all non-urgent procedures until the end of January.
The move is designed to free up staff and beds to deal with emergency patients and is expected to affect around 55,000 operations such as cataracts and hip replacements.
British Prime Minister Theresa May apologised to patients whose operations had been postponed while visiting a hospital on Thursday.
“I know it is difficult, I know it is frustrating, I know its disappointing for people and I apologise,” she said.
Healthcare staff are always under pressure in January as cold weather, flu and higher levels of respiratory illnesses put hospitals under strain.
“The NHS is currently experiencing serious challenges due to peaks in demand that occur during the winter period,” said Andrew Seaton, a historian of the NHS at New York University.
“This has become somewhat of an annual event, though this year looks particularly serious as 21 NHS Trusts have declared a ‘black alert’, meaning they can no longer guarantee patient safety, nor run a full range of services,” he told Al Jazeera.
This winter has seen reports of individuals waiting 12 hours to see a doctor and patients being treated in corridors.
New data released by NHS England on Thursday showed a 95 percent rise in the number of patients stuck in ambulances for at least an hour during the week of December 25-31 – with 4,700 cases up from 2,400 the week before.
Department of Health guidelines say ambulance crews should be able to hand patients over to hospital staff within 15 minutes of arrival.
Underfunded and under stress
Insufficient funding by successive governments, creeping privatisation and an ageing population have combined to create a difficult situation for the British healthcare system and those who work in it.
“The population we care for has changed,” said Dr Rashed Akhtar, a general practitioner who works between the NHS and private care.
Dr Aisha Awan
“We have an ageing population living longer with more complex diseases. Something like dementia, which you can survive a long time with, is still an illness that is very demanding to care for and something I don’t think as a society we’ve got to grips with,” he told Al Jazeera.
“The resources for the NHS have not matched the needs of the population.”
Staffing shortages are exacerbating the situation, placing additional strain on healthcare providers.
“We cannot find GPs to fill vacant spots,” Dr Aisha Awan, a Manchester-based GP told Al Jazeera.
“NHS staff really do go above and beyond: they don’t charge by the hour, they stay late and, as a result, they’re tired and spending less time with their families.
“The NHS is in part surviving because of the enormous goodwill of staff, but general practice and most specialities are underfunded and almost all clinical staff are feeling stressed and pressured,” she said.
The NHS remains a key political issue in the UK and was central to campaigns during both 2017’s Brexit vote and the general election.
As the UK moves ahead with preparations to leave the European Union, the service’s staffing problems look set to worsen.
Andrew Seaton, New York University
“Staff recruitment and retention is a huge problem,” said Akhtar. “Doctors, even at very early stages in their careers, are going to work in places like Australia, New Zealand and Canada where the work-life balance is better, they have less paperwork, and can spend more of their time with patients.
“On the cusp of Brexit, one wonders how the gap from that is going to be filled. By limiting migration, the medical profession is likely to suffer and people are likely to suffer,” he said.
Seaton agreed, noting some of the NHS’s EU and overseas workers, more than 17 percent of the service’s total workforce, are leaving because of Brexit uncertainty.
“The NHS has always relied on overseas workers, right back to the very beginning when it quickly began recruiting doctors and nurses from Commonwealth nations. It would not have lasted without them,” he said.
A national religion
The NHS was founded in 1948 by health minister Aneurin Bevan under the Labour government of Clement Attlee in a wave of post-war social reforms.
Today, the service employs more than one million people and remains an important part of British life.
Professor Ian Greener, University of Strathclyde
“The NHS enjoys an unparalleled degree of public affection for a welfare institution,” said Seaton.
“It has not only survived but increased its emotional pull on the public,” he told Al Jazeera.
Nigel Lawson, former Conservative MP and member of Margaret Thatcher’s cabinet, famously described the NHS as “the closest thing the English have to a religion”.
“I think that’s still largely true,” said Ian Greener, a professor of social policy at the University of Strathclyde.
“There’s a sense that it’s something important in our society and culture,” he told Al Jazeera.
“It’s there at our most vulnerable times: it’s there when we’re born, it’s there when we die, when our children are born and when our loved ones are sick.”
The service’s value, both financial and emotional, is passionately defended by NHS workers.
“We do compare ourselves to other healthcare systems but pound for pound we are better value than any other healthcare system in the world,” said Awan.
“I think it’s a fundamental right that every single person has access to healthcare. We don’t want a system like America, we don’t want a system where the most vulnerable are systematically deprived of good care because of their position in life. People shouldn’t have to make life and death decisions.”
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