'Fighting for Life' by Isabel Hardman

This year is the 75th anniversary of the NHS, so naturally a few books have been published to commemorate the occasion. Hardman's 'Fighting for Life' is a pop history of the institution, framed around 12 battles which shaped the NHS into what we have today. I would recommend it, with caveats, to those who work in or with the NHS, or use its services regularly. 

I found it an enlightening reading experience which helped me contextualise my working life into the story of the NHS. Hardman is a political journalist - her previous book, 'Why We Get The Wrong Politicians', is excellent and one I include in my canon of 'Books That Exacerbated My Disillusionment With British Politics - but this means her NHS book is largely focused on the political personalities and arguments within government and parliament about NHS reforms. While I personally was engrossed (in another life I could imagine myself as a policy wonk), I imagine many people would find this political focus quite boring, especially if they don't go into the book with some pre-existing knowledge about UK politics.

The NHS is a political football; Hardman deftly shows the various ways all political parties have, often hypocritically, attacked each other over the NHS. She explores the realities and misunderstandings behind the fear, present since the inception of the service, that there is a secret plot to dismantle or privatise the NHS, and replace it with an American-style system. Like any good conspiracy theory, there are grains of truth to it: a small faction of the Conservative party does admire the American system, but are aware that going down that route in Britain would be political and electoral suicide on a truly colossal scale. 

Politicians are often frustrated that popular political discussions about healthcare in Britain are framed around, and therefore extremely limited by, the false dichotomy between the state-run NHS model and the American-style private hellscape, ignoring the myriad other ways that countries fund and manage their healthcare. Both Labour and Conservative governments have increased private sector involvement in the NHS and added charges, though Labour tends to get away with it because they are more trusted on the NHS.

Across the 12 battles, which range from early arguments over whether there should be an NHS and how it should be structured and funded, through many reforms and modernisations, to the COVID pandemic and the many crises that face the post-pandemic service, we learn about the origins of prescription charges and CQC inspections,; the uses and abuses of performance targets; why maternity units are particularly scandal-prone; the growth of the culture of cover-ups, bullying and blame; the many arguments between Health Secretaries and Chancellors over funding; and much, much, much more. 

The picture that emerges is of a vast, complex, bureaucratic system that is slow to change but has changed so much. A service which very few people even begin to understand, even as they claim to adore it. An institution that is extremely impressive and successful, but creaking, straining, and intensely suffering from deep seated problems exacerbated by recent systemic shocks. 

The final chapter ends with an attack on the shallowness of current NHS discourse, and a call for action for someone, or several someones, to actually do something about it:

'There has been enough lovebombing from politicians too fearful or lazy to confront the truth about the state of the service and what it needs. Now, it needs someone who knows what they are really fighting for. Depending on how well they fight, it could either be the latest or the last battle of the NHS's long struggle to exist'.