SEVENTY years on the basic values of the NHS remain intact: ‘Free at the point of need, irrespective of circumstances’.

In the nineties, when I was visiting the US regularly as part of a joint research project with colleagues at the Mayo Clinic, I was struck by the fact that forty percent of personal bankruptcies in the US are caused by health costs.

Our NHS protects the vulnerable and takes away the fear of the financial costs of illness.

Aneurin Bevan got a lot right in creating the NHS but his belief that, with improved health, the costs of the NHS would diminish, was badly wrong.

We now know that with advances in medicine, the improvements he predicted have resulted in much longer life expectancy. But at the same time everyone is surviving with more costly medical conditions.

The challenges of high levels of infant and maternal mortality have been overcome. Infectious diseases, such as tuberculosis, have been largely eradicated, at least for the moment. Heart disease is reducing and cancers are being cured.

The biggest challenge of our generation is how to fund social care. I was proud that the Labour-led Scottish Government introduced free personal care following Lord Sutherland’s report.

But those needing care in the community or in a care home, who are usually suffering from dementia or serious frailty are faced with a detailed financial assessment. Those who are the least well off are fully funded.

Those who have significant income will manage the costs without spending capital. But those with modest savings and a modest income will have to spend their savings until they are degraded to level which attracts full funding.

I have argued, as have others, that this is not just. A number of proposals have been made but never with cross party agreement. This challenge must be met.

Meantime the NHS, through its vaccination programmes, has hugely reduced the burden of many diseases.

The screening programmes which identify early disease are undoubtedly saving lives.

Preventing disease has long been a goal but requires many factors outside of medicine to be addressed: poverty, homelessness and poor housing, unemployment and underemployment, pollution and lifestyle issues in nutrition, alcohol, drugs, tobacco and physical activity.

The NHS, with its dedicated staff, remains the jewel in the crown of our country, but it is largely a patch and mend service and cannot alone improve the health of our citizens.

Richard Simpson OBE, FRCGP, FRCPsych, was a GP and psychiatrist for almost 35 years and Labour’s shadow public health minister in the Scottish Parliament 2007-2016.

He is currently honorary Professor of Health and Sport Sciences at Stirling University and visiting professor at the medical faculty at the University of St Andrews.