The British show a mixture of pride and embarrassment when they speak about the National Health Service, and contrast it to health systems based on private health insurance.

We are proud of the cherished NHS principles: that it is ‘free at the point of use’ and that treatment is decided on the basis of a patient’s needs rather than the depth of his pocket. Those are sources of justified pride. Private health schemes cannot claim these virtues. However, they do with reason claim a greater sophistication and an ethos of caring for individuals in a more comfortable and individual way.

In terms of comfort and luxury as opposed to medical care, the NHS standard is indeed a basic one and that can be the cause of embarrassment, when the state of NHS hospitals is compared to the higher standards of comfort and even hygiene which often seem to obtain elsewhere. It is partly because of this that many choose to opt out of the NHS, and rely on privately funded care for a less traumatic experience when a serious illness strikes them or a family member. The draw-back of private insurance is of course that all insurances have a financial limit and when that runs out, care may no longer be funded. However, at that point the patient has the right to return to the NHS.

Provision of health care has always been contentious. The post 2nd world war UK government spent long hours and months at the negotiating table arguing with doctors about the terms under which the National Health Service would come into existence. The compromise which was eventually reached was one which allowed for the continued existence of the private sector, and since then it has continued to thrive alongside the NHS.

In recent years we have seen the influence of a more conservative political climate, increased influence from the United States, together with increased expectations which have grown along with scientific advances. These factors have fed into an expanding and successful private sector, which has continued to grow alongside an NHS which is itself better funded than ever before.

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