It was a bit of a family joke, but not much of one really: as a child, my mum was often reminded she’d been born in the workhouse – the point being she should be grateful for what she had.

In reality, the reference was to her being born in the old Walton Hospital (rather than at home) which had been built as a workhouse in 1869, but by the 1920s had become an infirmary for the community as a whole rather than for paupers alone.  In 1948, along with all the other surviving workhouse infirmaries, it was incorporated into a new National Health Service.  Although we’re still some time away from the NHS’s 70th anniversary, the media is already awash with analyses, recollections, and predictions for its future.

Walton Workhouse
The “Walton Institution” (Image from The Liverpool Echo, 29 June 2015)

It won’t be long until I too hit 70, and – for the record – I was born in a workhouse as well, in Birkenhead.  You’d think they’d all be gone by now but for many towns and cities the old workhouse still remains as the centre of local NHS services.  Where my mum was born, the Walton Workhouse had been one of those huge Victorian edifices designed to either intimidate or inspire, depending upon your status.  It was a three storey building with a huge central clock tower and designed to accommodate 1,200 paupers although by the 1930s it could accommodate twice that number  It was demolished many years ago, but in my present community the old Watford workhouse on Vicarage Road remains as part of Watford General Hospital and the centre of some of south-west Hertfordshire’s specialist medical services.  Watford is a smaller town than Liverpool, so in the 19th century it didn’t outgrow its workhouse provision, so the original buildings survive and date from 1835.

Watford Workhouse
The former Watford Workhouse, built 1835.

The facility was already more than 100 years old when it became part of the NHS in 1948 (no, it has not worn it well).  Meanwhile, back at the Birkenhead workhouse (1861-2011), an online calculator tells me that I was probably the 133,580th baby born into the NHS out of the 44 million or so of us delivered by the NHS since then (check your own position in the list: click HERE for link ).

I can’t really imagine what my life today might be like without the NHS.  It’s provided the vaccinations and injections ensuring I’ve never caught polio, diphtheria, smallpox, TB , malaria, tetanus, flu, or a range of tropical diseases.  There have been prescriptions, X-rays, cancer screenings, minor ops, GP services, eye tests, specs, dental treatment, and physiotherapy.  And this is before I start to think about the life-saving interventions and coronary care.  Putting not too fine a point on it, without the NHS I probably wouldn’t be writing this.

What many of the politicians and commentators don’t get about the NHS is the immense amount of goodwill that the organisation depends upon on.  Obviously resources are important, but even the most expensive resources in the world in themselves wouldn’t be enough.  That’s because the best resources aren’t the most expensive ones.  It’s not the technology, or the miracle drugs, or the advanced surgical techniques, but the people.  The ancillary staff and the porters, the nurses and the doctors, the technicians and the pharmacists, the dieticians and physiotherapists, the students and the volunteers, the chaplains and the hospital visitors.  The trouble is you can quantify the costs, the staff numbers, the patient numbers, and measure outcomes, but you can’t measure the extent to which people do willingly more than they’re paid to do, and without complaint.

It’s our money that funds the health service, from the taxes and national insurance contributions we pay.  Treatment is, mostly, free at the point of access.  In as much I’ve had to pay for prescriptions or dental treatment I know the bill has only been a fraction of the full cost.  Anyone who has taken a pet to the vet for treatment will have some idea of the market rate for professional medical services and prescribed medicines.

And yet parts of the media, some politicians, and some political commentators continue their assault on the integrity of the NHS and its staff by extrapolating from occasional incidents of malpractice, and condemn the whole organisation as dysfunctional and not fit for purpose.  With over 1.5 million employees it’s the biggest employer in the UK and the 5th largest employer in the world (after the US Department of Defence, the Chinese Army, Wal-Mart and McDonalds) so it’s not surprising that micromanagement from the centre isn’t going to work.

Yes, it could be more efficient, and maybe more effective, but that’s because the organisation has been designed by politicians and we all know how successful they have been at organising things like the railways, or prisons.  Yes, we loved the tribute to the NHS with nurses bouncing on beds, in the opening ceremony of the London Olympic Games in 2012.  Yes, people say they would pay more tax to further support the NHS, but it’s the politicians who scare us into believing that we can’t afford it.

No, it isn’t particularly expensive when you consider that many countries pay proportionally more for their health care, and therefore it’s not much surprise that some of their health outcomes are better.  International comparisons indicate the NHS is averagely funded, and performs averagely well. (Data on NHS performance can be found by following this link HERE.)  But it’s the place where many medics from around the world want to work, and a good job too; we need their contribution because our own government seems hell bent on discouraging our own young people from becoming medical, nursing or  healthcare professionals by making it more and more expensive for them to train.

The old workhouses were, 180 years ago, part of the response to the social and economic changes which exposed the inadequacy of the established means of supporting the poorest and most vulnerable members of society.   By 100 years ago there had been further social and economic change which rendered the workhouse system itself effectively obsolete.  The spectre of the workhouse may have been abolished, but the stigma of the workhouse, of dependency, continued.  The NHS was part of a platform of reforms established during the 1940s to create a new “welfare state,” yet it’s becoming increasingly evident that there have been further significant social and economic changes that have rendered much of that welfare provision as redundant as the workhouses became 100 years ago.  We need a new William Beveridge to imagine a welfare state fit for the realities of life in Britain in the 21st Century.  I expect this will be a theme to which I return.