Societies have different images of themselves, and of where they want to go. In the 1930s, as British industry lost its competitiveness and unemployment rose over a million, the British slowly, painfully abandoned their self-image as a world power, and gave up on their ambition to make India better. They decided to concentrate on bettering their own condition. In the middle of World War II, they appointed a committee on social insurance under Lord Beveridge. It identified Five Giants that a society must vanquish: want, disease, ignorance, squalor and idleness. Aneurin Bevan, the mercuric Welshman, became minister of health in the Labour government of 1946. He nationalized medical service, and created the National Health Service “to relieve your money worries in times of illness”.

As the NHS approached the end of 60 years, the Labour government ordered a review. Normally the British government would appoint a committee of neutral outsiders. But this time it left the choice to Lord Darzi, a Parliamentary Under Secretary of State (that is, minister of state) who was also a practising doctor; he continues to see his patients while he serves in the government. He appointed a committee of 11 fellow physicians. They asked the ten regional NHS administrations to produce their own reports, divided into eight sections — staying healthy, maternity and childbirth, children, acute care, planned care, mental health, long-term conditions and end of life. The regional groups, in turn, consulted their doctors, nurses and administrators and made up their own reports. The resulting national report, purported to have received inputs from 2,000 people, has been just published by the British government.

The focus of the NHS has been on treating the illnesses of the people. But the British find that many of the ailments are due to bad habits contracted years ago. Now they propose to concentrate on six of them.

First, excessive and wrong eating and lack of exercise make people fat. The British are not a particularly overweight people — they have not reached the levels of the Americans. But some of their children acquire bizarre shapes out of obesity; and many more are clearly overweight. So they will concentrate on educating people to eat more sensibly.

Second, many young people consider it a sign of maturity to drink, and some of them begin to drink heavily and chronically. Drunkenness leads to rows; and people who do not have enough money to drink turn to theft and robbery. Once someone becomes addicted to drink, it is difficult to cure his addiction. He has to be confined to what is essentially a jail, and has to be watched all the time to make sure he does not get hold of drink. So it is better to stop people before they become addicted.

Third, Britons smoke too much. Smoking does not lead to any psychological changes; unlike drunkards, smokers can live perfectly normally in societies, at any rate societies of people who do not have a tobacco-phobia. But smoking greatly increases the chances of lung diseases and cardiovascular diseases, which are expensive to treat and often terminal. So the NHS now wants to persuade people to stop smoking.

Tobacco is not the only weed that can be smoked. There are others, such as opium, cannabis and LSD which give different pleasures, are equally addictive, and have worse effects on living and working ability. Many young Britons acquire habits of taking drugs, and have to be detoxified at great cost. So the NHS wants to prevent drug addiction.

Sex is one of life’s greatest pleasures; Britons begin to enjoy it at an early age — often while they are in school. So they are susceptible to sexual diseases, which spread rapidly in conditions of indiscriminate sex. The NHS does not propose to prevent sex, but only to take up the cure and prevention of sexual diseases.

Finally, marriage has become an exceptional condition in Britain; and many Britons live alone. They become susceptible to mental diseases. Depression is the most common, but there are many others, such as paranoia and dementia. People with jobs keep in better health; those who are unemployed become susceptible to depression. The NHS will concentrate on tackling mental ailments.

Those who have been to hospitals or suffered serious ailments know the feeling that they have become playthings in the hands of doctors. At least in this country we can go to another doctor or hospital if we do not like one. In Britain, where no such choice is given, the feeling of helplessness is widespread. The British government is thinking of a number of remedies for it. It proposes to draft an NHS constitution, by which it means a patients’ bill of rights. It proposes to upload patients’ test results on the web; they will be viewable by the patients and those who treat them. Another website will contain information about ailments, their treatment and best practices. Doctors will be asked to spend more time explaining their diagnoses to patients. Some patients will be given a sum of money, which they can spend on treatments of their choice. However, they will not get the money in hand; and the personal budget will not be used to limit their demands on the NHS.

Most of us go to a doctor or a medical establishment when we get sick, and then forget all about it till we get sick again. This is the wrong thing to do for long-term and chronic diseases, which require strategic, sequential treatment. Britons are usually attached to a general practitioner for much of their lives; periodic visits to him would ensure continuous treatment. But in some countries, the practice is emerging of doctors working out a long-term plan for such patients, sharing it with them and following it up over time. In Germany, for instance, it is customary for someone who undergoes a serious operation to be sent to a rehabilitation centre, and also often for physiotherapy. Britain wants to introduce such long-term plans on a larger scale.

These are some of the changes proposed to be introduced in the NHS. Are they the right things to do? Will they make the NHS significantly better? I am not entirely sure. The NHS is imbued with an ideology, and every ideology creates its own jargon. Whilst the report (High Quality Care for All) is clearly written and beautifully produced, it is written in such an anodyne style that one wonders how many problems it conceals.

There is also a British way of doing things. They created a monopoly in the NHS, and then tried to control its quality by setting standards. There is a better way of improving quality; it is to introduce competition. The British keep creating new institutions within the NHS in the hope that negotiations between them will be a substitute for competition. But it is not. They would not countenance letting patients choose doctors and hospitals, and letting hospitals use their performance to attract patients. I think the only good component of the NHS is a doctor within walking distance of every Briton. The government should provide for him; the rest of the system would work better with competition.