Half the population in 1939, including most women and children, had no formal entitlement to care, relying on voluntary, local authority and private provision. How ironic then, that those early beneficiaries
as children are now threatening to be its Achilles heel.

On the whole, the average Briton uses the NHS only fleetingly within his adult life; new birth and the occasional accidental injury being the two most frequent occurrences. Indeed, we are largely
undemanding of the NHS until we reach the age of retirement. And herein lays the dilemma for future Governments.

The "Baby Boomer" generation – those born between 1945 and 1960 – is now becoming an increasing burden on the NHS purse. We have long exceeded the amount of care and treatment that our population can afford.

The herald of free health care, Aneurin Bevan, assumed upon the inception of the NHS, that once all the bad teeth had been extracted, and all the hernias and haemorrhoids dealt with, that health care would
cheapen. Far from it. The rapid increases in technology and the wider availability of newer drugs were predictably more expensive than their predecessors.

As a result, NHS rationing has become something of an inevitability. Successive governments have tried to solve this dilemma by repeatedly reorganising the NHS. This expensive administrative endeavour is never truly costed and the public are rarely aware of it. Nor are clinicians, who are the spending agents of the service who just ignore the political sloganeering by Ministers and carry on as they were trained to.

The intention of reform is always to get some spurious improved return for taxpayer's money, but many think it nothing better in terms of outcomes that re-arranging the deckchairs on the foredeck of the Titanic.

However, the NHS has a rising tide of elderly people waiting in the wings. The elderly have numerous age-related impairments that don't necessarily kill, but they don't go away, and medicine can indeed make life easier.

However, the aura of having a pill for every ill is a mirage. Given the political potency of the NHS – it is always among the top three issues at most elections – the electorate need to be kept calm about its capacity, or lack thereof, to look after those dodging the coffin. So what, therefore, are the options?

None of them are pretty. Perhaps the most obvious would be for the Government to raise the income tax that pays for the bulk of the NHS. The only problem is no-one votes for an increase in PAYE.

Alternatively, they can divert money from other spending ministries. Yet this is not without political risk, especially if we starve our lads in Iraq and Afghanistan of resources like body armour and bullets as a result.

The National Insurance contribution is another target that has already been used as a stealth tax to subsidise the increasing burden on the NHS. Similarly to income tax, any increases made transparent are guaranteed to be universally unpopular.

A third option could be made to seek out private insurance, but of course policies have exclusion clauses and no company is willing to insure us for ailments such as the occurrence of Alzheimer's that has an increasing risk to age factor.

Aside from those three, perhaps less than ideal solutions, what can be done to save the NHS? Gordon Brown commissioned a very detailed investigation in 2002 in which Derek Wanless, Commissioner with the Statistics Commission, projected 20 years hence.

Several possible scenarios were identified, with the best case suggesting that tax-funded health care would be affordable if we all adopt the lives of Trappist Monks and forever forswear a good English breakfast – if we all become vegetarian joggers, we all deserve to live forever!

And although not voiced as such, the worst case scenario forecast a future where the government means-tested provision for the majority of elderly dependent people. In truth, this is not dissimilar to our current social care system in England, provided by the goodly home helps and social workers. This is means tested to the point where people may have to sell their property to pay for rest home care.

The final blow is perhaps yet to be dealt – an increase in the length of time we work before retirement, by which time we will have lost the strength to suck a Werther's Original.

So in the future when we have a retirement collection for colleagues, it will not be for a pair of walking boots or some garden tools, but for a contribution to a stair lift, a bath with a door in the side, or "lav nav" in case we ever laugh so much that we wet ourselves.


Professor Peter Bradshaw is a Senior Lecturer in the School of Human & Health Sciences at the University of Huddersfield.