The National Health Service is held in some high regard, and with considerable affection. People love it for the high principles it embodies, the protection and security it offers and (for the most part) their experience of its service – there are few families where no one has experienced a serious illness. The NHS is, a former Conservative chancellor famously observed, ‘the closest thing the English people have to a religion’. The rationale for the NHS is both moral – it represents a moral commitment and a right to welfare for everyone in the community – and practical. The service has been, for most, the very model of the welfare state – a universal service, free to all at the point of delivery.

Despite that, it has also been the subject of continual criticism. The criticism has abated during the coronavirus crisis, but there is no reason to expect that it will be quelled for the next few years. Some part of the criticism has been based in a loss of respect for the expertise of the medical profession, evidenced partly in press reports about failures, and partly by the increasing numbers of cases taken against doctors and health trusts for negligence or malpractice. Some part, too, has been political. Since the 1960s, there has been a steady stream of commentators ready to say that it could all be done better if only more was done through the private sector. And part, perhaps, is intrinsic to the nature of the NHS. The NHS, the Prime Minister has said, is ‘powered by love’. That, the Economist comments, is genuinely true, some of the time: ‘but it can also run on anger’. Enoch Powell, a former Minister of Health, wrote nearly sixty years ago that everyone in the NHS had an interest in saying that it wasn't good enough, because that was the way to get better funding. A private firm tends to attract business by claiming that the service it provides is wonderful, even if it is on the brink of collapse. The NHS, by contrast, rewards ‘shroud waving’ – showing how awful the consequences of underfunding can be.