The National Health Service is famous for being free at the point of need, but analysts say that if the 60-year-old NHS is to serve an ageing and expanding population, the reality of its cost must be accepted.
The anniversary of the NHS, launched on July 5, 1948 by then Labour Health Minister Aneurin Bevan as a cradle-to-grave system, has prompted an avalanche of reviews and studies into its - and the nation's - future health.
Views vary on how to provide the best service for the NHS's 60 million users, but analysts agree on one point: Britain's public and its politicians must accept that the cost of the world's largest publicly funded health service is going up, and acknowledge it is a luxury, albeit one this society can afford.
"We have become fixed on the idea that the NHS is somehow free," David Furness, a health service analyst at the Social Market Foundation think-tank, told Reuters.
"It is not free. We all pay for it through taxation, and it's free at the point of use - that's something quite different. There are no blank cheques, but we should be celebrating the fact that our health system can give so much more than anyone ever imagined it would in 1948."
In terms of sheer size of personnel, only China's People's Liberation Army, America's giant Wal-Mart supermarket chain and India's enormous railway system compare with the NHS.
With a workforce of 1.5 million people across Britain, it is Europe's largest employer, and it deals with eight patients every second.
Analysts say a reluctance to recognise the costs of the NHS leads to a lack of realism when it comes to discussing reforms or possible limits on what it can and should provide.
The state of the NHS, seen as the crown jewel of Britain's welfare state, is intensely political. Waiting lists for operations, waiting times in emergency rooms, and working conditions for medical staff all pop up regularly as campaigning issues ahead of elections.
During more than a decade in power, Prime Minister Gordon Brown's Labour Party has increased spending on health care dramatically, but his opponents say he and predecessor Tony Blair did not go far enough to change how the system is run.
PLANS FOR CHANGE
A major government-commissioned review by Health Minister Ara Darzi, published this week, said the NHS of the future should focus more on the quality of care, not on quantitative targets like cutting waiting times, or waiting lists.
That shift was good news for many in the medical profession.
"We welcome the general tenor of Lord Darzi's report that the future emphasis should be on the whole patient/client experience in the NHS - from the quality of the consultants' care to the standard of the food - rather than the crude managerial targets of recent times," said Karen Reay, health officer for trade union Unite.
But as the King's Fund health care think-tank pointed out, the 140-page report had "two significant omissions".
"There are no estimates of how much all this will cost and no indication of just how different the government expects the quality of health services to be in five or 10 years time," said Niall Dickson, the Fund's chief executive.
The review was slammed by the Conservatives, which is riding high in the polls as Brown's popularity slides.
"The complete lack of vision in these proposals means that, sadly, the government has missed its 'once-in-a-generation opportunity' to enact the real reform that our NHS needs," said Conservative Health Spokesman Andrew Lansley.
