1948 vs. 2025: Has the NHS Kept Up with the Times?

A system built for acute care and cohesive communities is buckling under chronic burdens and social isolation

On 5th July 1948, Prime Minister Clement Attlee introduced the National Health Service (NHS), offering healthcare free at the point of use, funded through taxation. The vision suggested that medical care was a right for all, not a privilege for a few. It was revolutionary, built for a country still reeling from World War II, with a life expectancy of just 68 years and a very different disease burden. But does this model still work in 2025?

The NHS was designed for the Britain of 1948, a country where:

Healthcare demand was lower. The population was younger, with infectious diseases like tuberculosis/pneumonia as leading killers. Treatments were basic and inexpensive.

The economy was different. The UK was emerging from war but had strong economic growth, with high employment and a rapidly industrialising workforce. Today’s economy is sluggish, with rising deficits and a workforce stretched thin by health-related absences. Our Chancellor is struggling to revive our flat lining economy whilst trying to resuscitate our public services.

Social care was largely informal. Elderly care was managed by families, who lived in close-knit communities. Children used to live close and there was a duty to look after the old. Now, families are more dispersed, and social care relies on an overstretched system.

In 1948, the average Briton lived to around 68 years old. Today, life expectancy has risen to 82 years. That’s a medical success story, but it also means more people living with dementia, heart disease, diabetes, and cancer—chronic conditions that require costly, long-term care.

Back then, a heart attack was often fatal. Now, patients survive thanks to statins, stents, and bypass surgeries—each requiring years of ongoing treatment. In 1948, cancer was usually a death sentence; now, it’s often treatable, but with expensive drugs, radiotherapy, and immunotherapy. The NHS was designed for acute care, not the long-term maintenance of chronic conditions that dominate today’s health landscape.

The economic landscape has also drifted massively. In 1955, the UK spent just 3.5% of GDP on healthcare. By 2022, it had risen to 10.4%. The NHS now consumes 30.1% of all public spending, compared to just 11.2% in the 1950s.

One of the biggest failings of the NHS today isn’t even within hospitals—it’s in social care. In 1948, families typically looked after aging relatives. Today, many elderly people live alone, requiring government-funded care.

• 1.6 million elderly people have unmet social care needs.

• Hospital bed-blocking is at record levels, as elderly patients cannot be discharged due to lack of care at home.

• The cost of social care is set to rise to £40 billion by 2035, yet funding remains stagnant.

This wasn’t a consideration in 1948 because the social fabric was different. But the NHS today is expected to pick up the pieces—something it was never designed for.

The NHS was a marvel of its time. It was a system built for a younger, healthier, and more cohesive society. It was designed for a Britain that no longer exists. Britons are proud of the NHS, but nostalgia won’t change its problems in the 21st century with complex economic and social demands. Without radical reform, it risks being labelled as unfit for purpose.

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The Last Round: When To Call it a Day?

The image of a doctor practicing beyond their prime lingers. We owe it to our patients and colleagues to know when to hang up the stethoscope. Ageing inevitably affects processing speed, memory, problem-solving, vision, and hearing. Yet, many senior doctors argue their accumulated knowledge and experience compensate for these declines.

A 2014 survey of 1974-1977 graduates showed an average retirement age of 59.6 years, with surgeons (60.1), hospital doctors (60.0), and radiologists (60.4) retiring slightly later. Compare this to the UK’s general retirement age of 65.1 for men and 63.9 for women. A report from the Royal College of Obstetrician and Gynaecologists recommended that colleagues between 55-60 consider stopping or cutting down on-call retirements.

Studies suggest cognitive rigidity can set in with age, hindering adaptability. Cognitive decline isn't just theoretical—research shows older physicians are slower to update outdated practices. We’ve all encountered that Consultant who probably should have retired a few years back. Likewise, there’s always the one who left too soon, leaving the department wishing they had stayed. The goal is to ensure we make the right decision when our time comes.

Tackling the Rise in Mental Health Diagnoses

How mental distress is under-diagnosed, but over-medicalised

When Wes Streeting sat down with BBC’s Laura Kuenssberg last week, he knew that the question of the UK’s spiralling health-related sickness absences would be put to him. In a previous On-Call article we spoke about how the UK is facing a unique problem with mental health, not seen to the same extent in other similar countries.

We know that throughout history, older populations have historically faced challenges staying in work due to poor health, but in 2025, the fastest-growing group of adults out of work are actually under 40. Benefit claims in this demographic have surged by 150%, with two key drivers: musculoskeletal conditions, but mainly, mental health issues.

The think tank, The Resolution Foundation, reported that people in their 20s were more likely to be out of work due to sickness than people in their 40s, attributing this to an increase in young people reporting mental distress, rising from 24% in 2000 to 34% in 2024. The previous government alienated parts of the electorate with phrases like ‘feigning mental illness’ and ‘lazy.’ While it is true that some individuals may exploit the system, branding all sickness claimants in this way is problematic. This week, Mr Streeting echoed similar concerns about overdiagnosis of mental health disorders contributing to the rise in health-related sickness benefits, whilst emphasising that many young people are not receiving the support they need to return to work

Susan McPherson, Professor in Psychology and Sociology at the University of Essex, has noted that while mental distress may be underdiagnosed, it is certainly over-medicalised and understanding this distinction between over-diagnosis and over-medicalisation is vital.

So is Wes Correct? a UK national survey of psychiatric symptoms conducted a decade ago found that a third of people with symptoms severe enough to merit a diagnosis did not have one. This supports the idea that the nation’s mental health is not over-diagnosed, so what is going on?

‘Diagnosis’ implies a clearly identifiable medical condition. However, much evidence suggests that the causes of mental distress are often social, economic, environmental, or rooted in past trauma. Despite a massive surge in antidepressant prescriptions, overall levels of mental distress have not significantly improved as we would have expected. So perhaps the distinct being missed is that mental distress is not inherently a mental health issue.

But where do we draw the line between typical human experience and mental disorders? Differentiating between human emotional fluctuations and clinical conditions through modern psychiatric evaluation is a complex challenge. Psychology defines a disorder as something that inhibits daily function or causes harm, but this remains subjective.

We can think of the ‘normal human experience’ as a spectrum, but where things become difficult is knowing when ‘normal’ crosses into pathological.

Unlike physical diagnoses such as rheumatoid arthritis, which are based on identifiable biological markers, mental health diagnoses rely on subjective criteria. These labels can sometimes do more harm than good, leading individuals to believe they have a fixed biological abnormality, fostering pessimism about ever getting better.

In response, Wes has pledged 8,500 more mental health staff to reduce waiting lists, with 1.6 million people currently awaiting referrals. While this acknowledges the need for better mental health support, it also raises pressing questions: Are we diagnosing too broadly? Are we offering the right interventions? And most importantly, are we medicalising aspects of the human experience that should never have been treated as illness in the first place?

“Following widespread news of another NHS recruitment disaster with retracted offers - this time in radiology, we demand a full public inquiry into the selection process with a clear strategy on how these life-changing mistakes will be prevented from happening again”

“Forever waiting for the email that tells me I need to resit my medical school finals exam due to an administrative error”

“Pope Francis’ discharge was delayed as the discharge letter didn’t make it to the pharmacy by 16:00. The Italian FY1 has been datixed. Sources say he could have been discharged last week but didn’t have a shower rail installed at home. He will remain in the patient flow chair. GP to kindly recheck his bloods in a week”

What’s on your mind? Email us!

Some things to review when you’re off the ward…

Where does the NHS budget go? We know 49% of day to day expenditure goes towards staff costs, but what about the rest? Check out a breakdown from the Kingsfund

The Royal Free bids farewell to its maternity unit as birth rates in North London have dropped by 14% over the past five years. (The Times) 

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MATCH Day! Feeling Wanted In Medicine

We recently spoke about the drawbacks of the performative elements of the US Healthcare system when it comes to treatment of patients. Yet, when it comes to Match Day, the US transforms it into something far more than an administrative process—it becomes a moment of validation.

There’s a psychological edge to the way the US system creates a sense of purpose. Instead of the UK’s “Congratulations, you have a job,” US graduates get a specialty that actively chooses them—with confetti and happy tears.

The process reinforces a sense of being wanted, rather than merely being assigned. In contrast, the UK system often fosters gratitude for employment itself, rather than excitement for a career path you have worked towards for years.