Where I was in general practice, a 'diamond geezer' was a respected, mature character, perhaps somewhat of a rough diamond, but a genuine survivor. Does this describe the National Health Service at 60, or, rather, should she now be pensioned off? Former Chancellor Nigel Lawson said the NHS was 'the nearest thing the English have to a religion'.[1] Its promise of care 'from the cradle to the grave' which (centrally funded from public taxation) was also free at the point of need, offered great relief for those who could not afford to pay, and for those who cared for them.

But as Rodney and Pearl Burnham note in their comprehensive review,[2] what cost £276 million in its first year is now costing £90 billion this year, and is set to rise. At a time of growing economic constraint, it may be the UK will have to review these grand plans. Financially and managerially, there are concerns about privatisation. Ministers recently caused controversy when they announced that private firms could be drafted in to run struggling NHS hospitals and primary care trusts in England.[3]

Meanwhile, there is growing discontent among staff. On pay, members of Unison, Britain's biggest health union, voted (perhaps against expectation) to accept a three-year pay offer from the government,[4] joining the Royal College of Nursing, but while these 1.1 million employees have settled, many midwives, cleaners and porters are still up for a fight.

Junior doctors are concerned about competition for jobs that means many face unemployment. Latest figures for England indicate that 18,000 doctors applied for around 8,800 training posts, with competition ratios as high as 25 to one in some specialties.[5] In addition, there are nationwide protests by juniors and by medical students that because of reduced working hours, free accommodation is being withdrawn, amounting to a pay cut of around £5,000 per year. This threat comes on top of fears of massive debts on graduation of more than £60,000, if the government raises the £3,000 cap on tuition fees to £7,000 when it reviews the system in 2009.[6]

There are tough times ahead and tough decisions to be taken that will never please all those involved, but it seems probable that the NHS will survive. CMF members may disagree about the best policies, but in the light of that key word 'service' we will surely want to do all we can to follow Jesus who said 'I am among you as one who serves'.[7]