Medical Futurology: The National Health Service and the Politics of Inevitable Conclusions

Abstract

The history of Britain's National Health Service is a history of crises: staffing shortages; insufficient capital investment; and a lack of infrastructure rendered worse by the absence of the long-term funding settlements needed to ensure the service's future. The “critical condition” (Darzi 2024:131; https://www.gov.uk/government/publications/independent-investigation-of-the-nhs-in-england) of the NHS in the present makes reflection on the future of the health service essential and unavoidable. However, the NHS is characterised by “forms of inertia” (Powell 1966:73; A New Look at Politics and Medicine) that, even as public dissatisfaction hits record levels, consistently undermines arguments for necessary change. Drawing on the example of workforce planning, I examine how efforts to imagine the future of and a future for the NHS have taken three forms: planned; tethered (to the past); and resisted. In this, I draw out why the NHS as an institution needs to be more central to radical geographical agendas and why geographers should be engaged in its future.