These three books, all published to coincide with the seventy-fifth birthday of the National Health Service, come at Britain’s best-loved and most expensive institution from different angles. Isabel Hardman, a sparky journalist and assistant editor of The Spectator, views the NHS through the lens of the political battles that have raged around the institution throughout its life. Andrew Seaton, an American-trained Oxford don and social historian, has produced an energetically detailed account of the evolution of the NHS into an institution that mops up roughly a third of what the government spends on public services and a tenth of gross domestic product. Phil Whitaker, a general practitioner worried about the shrinking role of his profession, focuses on family doctors, who make up the part of the NHS that people come across most regularly but who receive a dwindling share of the cash.
None of these books offers much in the way of comparison between the NHS and health care provision in other wealthy countries, apart from acknowledging that the American system is the most unsatisfactory. That is a shame, since America’s wildly expensive yet inaccessible arrangements are the wrong comparison point. The question that is not really addressed is how European countries such as France and Germany, with similar populations but different ways of paying for health care, can spend broadly comparable shares of GDP on health care (and smaller shares on hospitals) to the UK and still achieve better results. Does it make sense to provide the nation’s health care through an institution so enormous that it ranks as the world’s fifth largest employer (larger ones include the Chinese People’s Liberation Army and McDonald’s)?
Some of the conflicts in the history of the NHS that are lined up in Hardman’s Fighting for Life have mattered more than others. One of her most interesting chapters describes Enoch Powell’s term as health minister. Appointed by Harold Macmillan in 1960 to what he described as