When the NHS was formed in 1948, it was rightly heralded as a massive achievement in pulling together a host of different health services to produce a universal service freely available to everyone. There was one holdout group that extracted an eleventh hour compromise – the medical consultants. To reach agreement with them, Aneurin Bevan had to concede that some doctors could continue with their private work while still being employed by the NHS.
This reluctant concession has been at the root of many of the NHS’s problems ever since. It created a mechanism for some doctors to earn more money and for wealthier patients to get priority access to care. I believe it was the origin of long waiting lists because that created a reason to pay to jump the queue. It helped develop a market for private health care.
It was “The Elephant in the Room” even before that expression was used. It suited the medical elite and their affluent patients not to talk about it, but as health care has become more and more specialised, it has made some members of a noble profession look more like the medical Mafia, acting in their own self-interest rather than that of their NHS patients. The average hospital consultant now earns £118,000 a year and can opt out of non-emergency work at evenings and weekends. In reality, many consultants earn much more than this by working in private practice as well.
The universality of the NHS is rapidly disappearing. The group of people who will be most affected by this are the elderly who are the ones most in need and least able to jump the queue with the wave of a credit card.