In 2020, as well as its material role at the frontline of the COVID-19 pandemic, the cultural significance of the NHS rapidly intensified in the UK.
Clap for Carers and ‘thank you NHS’ rainbows appeared from nowhere. Captain Tom started doing laps of his garden to raise money for NHS Charities Together’s Urgent COVID-19 Appeal, and the appeal went viral on social media. Big corporations lined up to donate, bringing NHS branding into peculiar proximity to business including purveyors of gin and chocolate. On my own pandemic route to a local supermarket, I found a ‘thank you NHS’ poster outside the offices of an aerospace engineering firm.
At the time, much of this felt unprecedented, to employ a pandemic cliché. And yet it is better seen as the culmination of a process with significantly longer roots. Historian Jenny Crane argues that both celebration and defence of the NHS (as opposed to people’s local hospitals) came to prominence in the contentious politics of Thatcherite reforms in the 1980s. It wasn’t until the 1990s that a coherent ‘brand identity’ of logo and ‘NHS blue’ developed. In 2012, the opening of the London Olympics famously centred the three-letter acronym NHS, alongside Mr Bean, James Bond and Queen Elizabeth II, in a ceremony seen at the time as ostentatiously political. And then, we can’t explore the contemporary cultural significance of the NHS without acknowledging the infamous Brexit Vote Leave campaign slogan, painted on a battle bus that toured the country: ‘We send the EU £350 million a week. Let’s fund the NHS instead.’
Celebrating significant NHS ‘birthdays’ is itself another practice that has snowballed in recent years. As the NHS’s 75th birthday is celebrated in 2023, the NHS England website encourages people to ‘support the NHS’ through diverse actions: by working for it, volunteering, giving blood or joining the organ donor register, donating to NHS charities, walking, running, swimming or cycling 1,000 miles, or getting involved in research projects. The range of ways in which the British public might be enrolled in the NHS as a collective project has expanded since its creation, and, as I argue in my book, proactive national NHS-branded campaigns in search of donations and volunteers are a relatively recent initiative. Yet many of these contemporary manifestations can be traced back to the voluntaristic origins of many UK hospitals: the NHS has always been more of a collective achievement than acknowledged by the credit-claiming speeches that governments like to deliver.
One account of how Britain loves the NHS is that the population is ferociously, irrationally attached to a healthcare system that is crumbling under the ‘toxic cocktail’ of the last decade. As evidence for this story we can hold up the plummeting rates of satisfaction with care received reported by respondents to the British Social Attitudes Survey, along with remarkably high levels of agreement with statements like ‘the NHS is crucial to British society and we must do everything we can to maintain it’. An alternative story is that ‘nationalistic folktales’ about the NHS have come to stand in for any semblance of a British national identity, and that ostensibly progressive attachment to tax-funded healthcare is in fact a front for a ‘politics of heredity’, uncomfortably enmeshed with exclusionary views of where we draw the boundaries of healthcare entitlement.
Public relationships with the NHS are complex and multiple, and particularly poorly captured by a consumeristic interpretation of (dis)satisfaction. The NHS can mean many different things to many different people, all at once. In one newspaper column during the pandemic, sociologist Gary Younge identified this multiplicity in the Clap for Carers:
‘We are clearly not all clapping for the same thing… I am clapping for the NHS and the people who work in it, as my mother did; for the disproportionately black and brown migrant and low-paid labourers who keep the institution going, have done so since its inception and are now disproportionately vulnerable to both the disease and lockdown’s challenges. I’m clapping with pride that I live in a nation that has created and sustained this, but also with rage that they still do not all have the protective equipment or testing they need, and with hope that one day soon they’ll get the pay they deserve and the service the investment it needs.’
In How Britain Loves the NHS I explore a range of contemporary modalities of public engagement with the NHS: from volunteering in hospitals and donating money to NHS charities to celebrities making videos in defence of the NHS for the campaign group Keep Our NHS Public. And I explore the narrative strategies used in submitted reviews of healthcare on the website Care Opinion, noting the way that patients and carers invoke the NHS when describing great examples of care (‘thank you NHS!’) or carefully protect the NHS from blame when sharing examples of sometime startling failures in care. This wider set of stories of the NHS demonstrates the multidimensional nature of Britain’s relationship with it which goes well beyond any measure of satisfaction: cultural, affective, political, and always rooted in material experiences of healthcare’s ‘existential significance’.
Public love for the NHS is as often seen as a problem for the welfare state as an asset to be celebrated. On both sides of the political spectrum, politicians talk about the NHS being ‘put on a pedestal’, often implying that high public support for the NHS has protected it from either funding cuts or reform, or both. Neither of these are borne out by evidence: as Nigel Edwards from the Nuffield Trust has argued, the NHS in England has been subject to remarkably frequent top-down reorganisations. The NHS remains ungenerously funded in international comparisons of healthcare. At most, public visibility has cushioned services from the excesses of austerity, which nonetheless come back to bite as population needs, unmet by the depleted welfare state, become greater and more complex. Understanding public support for the NHS better, rather than pitting it against the other pillars of the welfare state, is an urgent task for our fractious polity’s uncertain future.
Ellen A. Stewart is Senior Lecturer and Chancellor’s Fellow in the Centre for Health Policy at the University of Strathclyde.
How Britain Loves the NHS by Ellen A. Stewart is available to download Open Access on Bristol University Press Digital. You can also order the paperback on the Bristol University Press website for £24.99.
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