In Danny Boyle's wonderfully creative and fanciful London 2012 Olympics opening ceremony, one scene baffled millions of foreign viewers. In it, the stadium floor turned into a sea of dancing and skipping nurses. At one point, they jumped up and down on massive hospital beds. They were real nurses from the National Health Service – the NHS – the beloved and bemoaned institution that is as quintessentially British as the Queen, the Beatles and black cabs.
Mr. Boyle, the show's director, was making a political statement as much as entertaining the masses – the NHS, for all its faults, was to be celebrated. Before the show, he told reporters that "everyone is aware of how important the NHS is to everybody in this country. One of the core values of our society is that it doesn't matter who you are, you will get treated the same in terms of health care."
I don't know if Harry Leslie Smith was in the audience, but he would have jumped as high as the nurses a quarter his age if he had been. Mr. Smith is 91 and a tireless supporter of the social safety net that, after the back-to-back miseries of the Depression and the Second World War, created the NHS. Most other Western countries, Canada among them and the United States notably not, banged together their own versions. To varying degrees, each of them is threatened by budget cuts and the vagaries of political ideology. But, like Mr. Smith, they, old and frail, keep soldiering on. But for how much longer?
Mr. Smith and I have had an e-mail and Twitter relationship for many months, although I have not met him. He grew up in a bleak, clapped-out town in Northern England, is a Second World War RAF veteran, immigrated to Canada and now divides his time between Belleville, Ont., and a farm in Yorkshire, England.
His pleas to keep the heart of the NHS alive and pumping have made him something of a hero in Britain. He might be Europe's oldest rebel and more than a few of us wonder why a man his age has reinvented himself as a crusader for the welfare state and social democracy. Shouldn't that role go to the young men and women who would suffer the most if the NHS were to endure death by a thousand cuts? Mr. Smith is, after all, close to checking out of the game, even though he appears in good health.
Mr. Smith's book, Harry's Last Stand, published this year, is a furious poem dedicated to the preservation of the welfare state, especially the NHS, and to attacks on those who would happily see it dismantled. He speech in September at the Labour Party conference in Manchester stole the show and made him a minor YouTube sensation. He earned two standing ovations and brought many delegates to tears.
"I came into this world in the rough and ready year of 1923," he said. "I'm from Barnsley, and I can tell you that my childhood, like so many others from that era, was not like an episode from Downton Abbey. Instead, it was a barbarous time, it was a bleak time and it was an uncivilized time, because public health care didn't exist."
He and his siblings often went hungry. His father died young and broken after he lost his job and was pushed out of the house since he could not longer provide for his family. They watched helplessly as Marion, Harry's older sister, died of tuberculosis at the age of 10, her body "dumped nameless into a pauper's pit." He recalled the "anguished cries" of a neighbour who was dying of cancer and could not afford morphine.
The stories of grief and pain in Depression-era Britain carry the book, which meanders between biography and rage against the system. The biography parts are the most compelling, for they remind the reader of the era when the absence of public health care could mean a miserable, short existence unless you had the money for private care. Few did.
Mr. Smith's book is timely. Britain's Labour Party has pinned its election fortunes on rescuing the ailing NHS with an extra £2.5-billion ($4.4-billion) a year. In response, David Cameron, the Conservative Prime Minister, has promised to "protect" the NHS and, indeed, health-care budgets have not been crunched since the Conservatives election victory. Still, the NHS is under a severe financial squeeze as demand for its services outstrips supply. Recently, NHS boss Simon Stevens said the "factory model of health and social care" cannot meet the soaring rates of obesity, diabetes, dementia and chronic disease.
Earlier this week, George Osborne, Chancellor of the Exchequer, unveiled a tough vision of Britain's fiscal future as budget deficits remain stubbornly intact and Britain's debt swells. There will be more austerity, probably much more, meaning that government services face a massive retreat. At the same time, all the parties are pledging that the NHS will remain more or less intact.
The promises are not credible and, already, almost everyone who can afford private health care in Britain takes it. The NHS's existential problems are not unique. Every country with a national health service in ailing Europe is asking how their health-care systems can remain affordable and useful.
Some public health-care systems will be forced into retreat; that's happening already. Others may not make it. But before the decisions are made to cut them down to virtual nothingness, the warnings of Harry Leslie Smith should be read. Life before the NHS was shockingly brutal. "I am not an historian, but at 91, I am history, and I fear its repetition," says Europe's toughest, oldest and most spirited warrior.