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Free For All
Britain's health service is dying. Gavin Francis shows us why we should fight for it. Since its birth in 1948, the powers that be have chipped away at the NHS. Now, Britain's best-loved institution is under greater threat than ever, besieged by a deadly combination of underfunding, understaffing and the predatory private sector. In the wake of the pandemic, we have come to accept a 'new normal' of permanent crisis and years-long waiting lists. But, as Gavin Francis reveals in this short, vital book- it doesn't have to be this way, and until recently, it wasn't. Drawing on the history of the NHS as well as his own experience as a GP, he introduces us to the inner workings of an institution that has never been perfect but which transformed the lives and health of millions, for free - and which has never been more important. For those who believe in the future of the NHS and its founding principles, this is essential reading from the bestselling author of Recovery and Intensive Care.
192 pages, Paperback
Published June 4, 2024
17 people are currently reading
182 people want to read
About the author
Gavin Francis
21 books138 followersGavin Francis was born in Scotland in 1975, and has travelled widely on all seven continents. He has crossed Eurasia by motorcycle, and spent a year in Antarctica. He works as a medical doctor as well as a writer.
When travelling he is most interested in the way that places shapes the lives and stories of the people who live in them.
His first book, True North: Travels in Arctic Europe, explores the history of Europe's expansion northwards from the first Greek explorers to the Polar expeditions of the late 19th and 20th centuries. It was nominated for a William Mills Prize for Polar Books. Of it Robert Macfarlane wrote: 'a seriously accomplished first book, by a versatile and interesting writer... it is set apart by the elegance and grace of its prose, and by its abiding interest in landscapes of the mind. Francis explores not only the terrain of the far North, but also the ways in which the North has been imagined... a dense and unusual book.'
In 2011 he received a Creative Scotland Writer's Award towards the completion of a book about the year he spent living beside a colony of Emperor Penguins in Antarctica. Empire Antarctica will be published by Chatto & Windus in November 2012.
When travelling he is most interested in the way that places shapes the lives and stories of the people who live in them.
His first book, True North: Travels in Arctic Europe, explores the history of Europe's expansion northwards from the first Greek explorers to the Polar expeditions of the late 19th and 20th centuries. It was nominated for a William Mills Prize for Polar Books. Of it Robert Macfarlane wrote: 'a seriously accomplished first book, by a versatile and interesting writer... it is set apart by the elegance and grace of its prose, and by its abiding interest in landscapes of the mind. Francis explores not only the terrain of the far North, but also the ways in which the North has been imagined... a dense and unusual book.'
In 2011 he received a Creative Scotland Writer's Award towards the completion of a book about the year he spent living beside a colony of Emperor Penguins in Antarctica. Empire Antarctica will be published by Chatto & Windus in November 2012.
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Displaying 1 - 23 of 23 reviews
September 8, 2023
(3.5) The UK’s National Health Service was established 75 years ago this summer, with the aim of making healthcare free at the point of use for everyone, funded not by charity but by taxation. Today, the NHS is limping along from crisis to crisis (every winter, basically) because it has been chronically underfunded. Any UK-based reader could tell their own story of ridiculous wait times*, I suspect.
Dr. Gavin Francis’s Intensive Care is the definitive Covid-19 read for me, and I admired his follow-up, Recovery, a personal and general history of convalescence. Free for All is most similar to the latter: a short book, impassioned and practical, that demands a social safety net.
Francis makes it clear that the governing party of the last 13 years bears the responsibility for this. The UK’s healthcare spending is lower than that of key European benchmark nations that have better health outcomes. The Conservatives’ goal seems to be to privatize health and focus on market demand. Francis argues powerfully that allowing healthcare to be driven by profit, as it is in the USA, is immoral and uncivilized.
His valuable perspective is that of a GP who has to pick up the slack in his clinics and is begged not to send any but the most desperate cases to overcrowded hospitals. Services are strained to the breaking point; private medicine, far from lessening the burden, increases it when patients revert to the NHS for follow-up care or repair of botched procedures. Meanwhile, the introduction of performance standards can divert doctors’ attention to ticking boxes and ensuring value for money rather than providing the best possible care. Overtreatment (mostly of the elderly) is another potential pitfall.
Francis elaborates his case through his work with anonymized patients, conversations with fellow medical professionals, and a frank look at the statistics on spending and achievements. The book is slightly dry compared to some of his earlier work, simply because of the subject matter, and I noticed a bit of repetition. However, it is still a concise and cogent manifesto. The author believes that people can show they value the NHS by electing politicians who will properly fund it. The NHS is, after all, “an expression of what’s best in our society” and “worth saving,” he concludes. Hear hear!
*Mine? I waited 12 months for a PHONE consultation with an ear, nose and throat specialist regarding tinnitus. By that point, of course, my problem had largely subsided.
Originally published on my blog, Bookish Beck.
Dr. Gavin Francis’s Intensive Care is the definitive Covid-19 read for me, and I admired his follow-up, Recovery, a personal and general history of convalescence. Free for All is most similar to the latter: a short book, impassioned and practical, that demands a social safety net.
Francis makes it clear that the governing party of the last 13 years bears the responsibility for this. The UK’s healthcare spending is lower than that of key European benchmark nations that have better health outcomes. The Conservatives’ goal seems to be to privatize health and focus on market demand. Francis argues powerfully that allowing healthcare to be driven by profit, as it is in the USA, is immoral and uncivilized.
His valuable perspective is that of a GP who has to pick up the slack in his clinics and is begged not to send any but the most desperate cases to overcrowded hospitals. Services are strained to the breaking point; private medicine, far from lessening the burden, increases it when patients revert to the NHS for follow-up care or repair of botched procedures. Meanwhile, the introduction of performance standards can divert doctors’ attention to ticking boxes and ensuring value for money rather than providing the best possible care. Overtreatment (mostly of the elderly) is another potential pitfall.
Francis elaborates his case through his work with anonymized patients, conversations with fellow medical professionals, and a frank look at the statistics on spending and achievements. The book is slightly dry compared to some of his earlier work, simply because of the subject matter, and I noticed a bit of repetition. However, it is still a concise and cogent manifesto. The author believes that people can show they value the NHS by electing politicians who will properly fund it. The NHS is, after all, “an expression of what’s best in our society” and “worth saving,” he concludes. Hear hear!
*Mine? I waited 12 months for a PHONE consultation with an ear, nose and throat specialist regarding tinnitus. By that point, of course, my problem had largely subsided.
Originally published on my blog, Bookish Beck.
January 4, 2025
a very digestible and accessible look at the history of the nhs + problems it now faces
nothing about the situation w the nhs is particularly new to me having spent an awful lot of time the past few years in hospitals, gp surgeries, and community health centres, but it’s always good to keep this at the forefront of your mind and try to understand the politics behind the everyday
some additional things i hadn’t considered ie problems with the idea of having a politically independent nhs governing body (loss of voter autonomy)
francis also writes v realistically but still expresses hope for the future of the service and it’s always nice to hear older physicians talk about how the service has changed over the years, reminds us that change is possible!!!!
nothing about the situation w the nhs is particularly new to me having spent an awful lot of time the past few years in hospitals, gp surgeries, and community health centres, but it’s always good to keep this at the forefront of your mind and try to understand the politics behind the everyday
some additional things i hadn’t considered ie problems with the idea of having a politically independent nhs governing body (loss of voter autonomy)
francis also writes v realistically but still expresses hope for the future of the service and it’s always nice to hear older physicians talk about how the service has changed over the years, reminds us that change is possible!!!!
January 14, 2024
Reflections and lessons learned/the content of this book made me feel…
“To say that the UK cannot match the healthcare spends of France, Germany, the Netherlands or Denmark is to suggest that; as a country, the UK is too poor to have a twenty-first-century European standard of healthcare - that economically we have fallen too far behind our neighbours. Or that we have reached a point in our society where wealthy people are no longer willing to subsidise the medical care of people less fortunate. Though successive politicians have voiced frustrations with the popularity of the NHS, that very popularity has paradoxically permitted levels of underfunding and underperformance that the public wouldn't have tolerated in a service that is less well-loved”
There’s only so many discussions that can end in ‘successive government funding failures’, ‘fingers in pies for the profit’, and ‘needing cross party controls’ when it comes to the NHS (although I think that I still can’t get onboard with the latter…). I felt confident when we, as NHS staff, were reaping the rewards from the PFI builds, providing us with lots of shiny new hospitals but perhaps this was the turning point that was going to take us down the big hill like in the game Tiny Wings - suddenly racing out of control towards the unknown as budgets spiral out of control around us? The knowledgable and experienced Francis admits the he doesn’t necessarily have the answers either, but maybe a return to the original words and intentions of Bevan 75 years on is what we all need… and maybe we can soar again on the other side of the hill yet with an institution that I don’t think anyone can argue doesn’t have a huge positive impact on the country when it works…
“To say that the UK cannot match the healthcare spends of France, Germany, the Netherlands or Denmark is to suggest that; as a country, the UK is too poor to have a twenty-first-century European standard of healthcare - that economically we have fallen too far behind our neighbours. Or that we have reached a point in our society where wealthy people are no longer willing to subsidise the medical care of people less fortunate. Though successive politicians have voiced frustrations with the popularity of the NHS, that very popularity has paradoxically permitted levels of underfunding and underperformance that the public wouldn't have tolerated in a service that is less well-loved”
There’s only so many discussions that can end in ‘successive government funding failures’, ‘fingers in pies for the profit’, and ‘needing cross party controls’ when it comes to the NHS (although I think that I still can’t get onboard with the latter…). I felt confident when we, as NHS staff, were reaping the rewards from the PFI builds, providing us with lots of shiny new hospitals but perhaps this was the turning point that was going to take us down the big hill like in the game Tiny Wings - suddenly racing out of control towards the unknown as budgets spiral out of control around us? The knowledgable and experienced Francis admits the he doesn’t necessarily have the answers either, but maybe a return to the original words and intentions of Bevan 75 years on is what we all need… and maybe we can soar again on the other side of the hill yet with an institution that I don’t think anyone can argue doesn’t have a huge positive impact on the country when it works…
June 14, 2025
Someone once said that the NHS is the closest the UK has to a national religion. And I’m very much a believer. I’ve grown up with it and seen it care for my family and friends. I now help to prepare students for UK medical school applications. With just a hint of religious passion.
But this is a very, very sad little book. It makes the argument that underfunding is at the heart of the current NHS crisis, making useful comparisons with healthcare spending per capita in other European countries. The author also knocks down the old argument that the NHS has too many managers: 5 in every 100 employees are managers compared to an average of 9.5 in other industries. He also makes a very convincing argument that lack of funding for social care has a knock on effect on the NHS: not enough OTs and care homes mean elderly patients have to ‘block beds’ because they can’t be discharged unless they can be cared for at home.
He seemed to dismiss AI as a diagnosis tool, which I’m not sure I agree with, but he describes NHS IT systems which are from the mid 1990s - frankly embarrassing for a rich developed nation like the UK. The technological infrastructure needed for AI to add significant value, as described in books such as Topol’s ‘The patient will see you now’ seems many decades away.
Above all, it makes a passionate case for healthcare which is free at the point of use. And I struggle to see an alternative. Privatization doesn’t work. Even Blair’s PFI has proved to be a costly mistake. I just hope future political leaders will read this book and be inspired to bring the NHS back to its former glory while utilizing the recent breakthroughs in medical technology.
But this is a very, very sad little book. It makes the argument that underfunding is at the heart of the current NHS crisis, making useful comparisons with healthcare spending per capita in other European countries. The author also knocks down the old argument that the NHS has too many managers: 5 in every 100 employees are managers compared to an average of 9.5 in other industries. He also makes a very convincing argument that lack of funding for social care has a knock on effect on the NHS: not enough OTs and care homes mean elderly patients have to ‘block beds’ because they can’t be discharged unless they can be cared for at home.
He seemed to dismiss AI as a diagnosis tool, which I’m not sure I agree with, but he describes NHS IT systems which are from the mid 1990s - frankly embarrassing for a rich developed nation like the UK. The technological infrastructure needed for AI to add significant value, as described in books such as Topol’s ‘The patient will see you now’ seems many decades away.
Above all, it makes a passionate case for healthcare which is free at the point of use. And I struggle to see an alternative. Privatization doesn’t work. Even Blair’s PFI has proved to be a costly mistake. I just hope future political leaders will read this book and be inspired to bring the NHS back to its former glory while utilizing the recent breakthroughs in medical technology.
January 21, 2024
Wonderful. Some great points about investing in community beds to reduce hospital stays, how technology can advance/hinder the NHS and the changes in morale in doctors from 30 years ago to now. Insight into the drawbacks of private healthcare - they may take strain off some NHS waiting lists but when procedures go wrong, patients end up back in the NHS for recovery and there is no mechanism to charge private healthcare for these complications.
Aneurin Bevan - ‘If the service could be killed they (Tories) wouldn’t mind, but to do it in a fashion that they would not appear to have responsibility’ .
💙💙
Aneurin Bevan - ‘If the service could be killed they (Tories) wouldn’t mind, but to do it in a fashion that they would not appear to have responsibility’ .
💙💙
November 28, 2023
Excellent as always from Gavin Frances.
Well worth a read and some consideration prior to the next election.
Well worth a read and some consideration prior to the next election.
November 22, 2023
My theme for this year has been:
a. Unfortunately, kinda ditch the reading challenge
b. Read multiple books at once (!!!)
c. Not be very good at keeping Goodreads updated - but I am reading, I swear :)
This was the opening gambit for the medical book club scheduled for tomorrow evening - and a welcome breath of validation of some sensible opinions I have also had throughout the years as an NHS employee. I feel this particularly hit home as Dr Francis is based in NHS Lothian, where I did my Foundation Training in 2014/2016 - it feels like not much has changed for the better since then. Short and very readable in one afternoon, this short-ish manifesto articulates some pervasive problems and also makes some sensible suggestions on how to solve them. Such as stop voting Tory if you still want to have a functional NHS in the near future :) Joking aside, it does a fairly good job of exposing the chronic under-funding and shortfalls that are kept hidden to most reputable media sources because, guess what, you're not really allowed to directly talk to the press as a doctor and all official communication should be made via your local trust's PR team. Which would pretty much try to convince you that the hospital isn't on fire in spite of a visible plume of thick smoke slowly rising from it.
Food for thought for British folk, I suppose.
a. Unfortunately, kinda ditch the reading challenge
b. Read multiple books at once (!!!)
c. Not be very good at keeping Goodreads updated - but I am reading, I swear :)
This was the opening gambit for the medical book club scheduled for tomorrow evening - and a welcome breath of validation of some sensible opinions I have also had throughout the years as an NHS employee. I feel this particularly hit home as Dr Francis is based in NHS Lothian, where I did my Foundation Training in 2014/2016 - it feels like not much has changed for the better since then. Short and very readable in one afternoon, this short-ish manifesto articulates some pervasive problems and also makes some sensible suggestions on how to solve them. Such as stop voting Tory if you still want to have a functional NHS in the near future :) Joking aside, it does a fairly good job of exposing the chronic under-funding and shortfalls that are kept hidden to most reputable media sources because, guess what, you're not really allowed to directly talk to the press as a doctor and all official communication should be made via your local trust's PR team. Which would pretty much try to convince you that the hospital isn't on fire in spite of a visible plume of thick smoke slowly rising from it.
Food for thought for British folk, I suppose.
April 27, 2024
A nicely written book that really gives some insights into the many challenges faced across all areas of the NHS.
It’s a book which keeps you waiting for the solutions, and for an NHS which is in desperate need of them, it can be a bit demoralising to read through so many desperate case studies and areas of diminishing quality. However, they’re all great points and serve to highlight the effects that a lack of sustained funding can have.
To elevate it to 4 stars or 5 stars I’d have liked to have read even more about the vision and areas of how the NHS can be saved, more ideas and stories about the link worker role and how this could be expanded and the impact this might have on primary care. Instead, sometimes great areas for further exploration are just touched upon and the book moves on. More room to breathe would benefit this fantastic little book.
Recommended?: for NHS staff especially. It’s safe to say that this book has made a difference to the way I think about the NHS and reinforced the way in which i feel about the NHS, both its problems and potential solutions. It’s a worthwhile read.
It’s a book which keeps you waiting for the solutions, and for an NHS which is in desperate need of them, it can be a bit demoralising to read through so many desperate case studies and areas of diminishing quality. However, they’re all great points and serve to highlight the effects that a lack of sustained funding can have.
To elevate it to 4 stars or 5 stars I’d have liked to have read even more about the vision and areas of how the NHS can be saved, more ideas and stories about the link worker role and how this could be expanded and the impact this might have on primary care. Instead, sometimes great areas for further exploration are just touched upon and the book moves on. More room to breathe would benefit this fantastic little book.
Recommended?: for NHS staff especially. It’s safe to say that this book has made a difference to the way I think about the NHS and reinforced the way in which i feel about the NHS, both its problems and potential solutions. It’s a worthwhile read.
August 19, 2024
An incredibly clear and concise collection of short essays about the state of our NHS currently, which seamlessly weaves potential solutions to the crises in between the stark statistics and moving first hand accounts from Dr. Francis. I really enjoyed the way this was written, with Francis somehow deftly combining the upsetting and challenging state of affairs of our current NHS with excerpts from Nye Bevan's original powerfully hopeful dream of the NHS, showing just how far we have strayed from the healthcare service can and should be. Francis masterfully combines these two things, somehow or other maintaining an upbeat, positive tone that practically addresses many of the problems that he identifies. An absolute must for everyone to read!
September 11, 2025
There are lots of different books on the NHS. Fee For All is a book on the NHS written from the perspective of a Scottish GP. The book has a lot of personal stories mixed with statistics as to why the NHS is in such a bad place.
Free For All offers many good examples of why the NHS still offers a positive healthcare system. There are a lot of interesting datapoints including the fact that Britain only spent 6.3 per cent of its economy on government spending in the mid1990s and that we are 40 billion pounds short on spending.
One disappointment is the poor referencing system. Why can't books just use endnotes? For goodness sake! Other than this book is a good quick read on the challenges of the NHS.
Free For All offers many good examples of why the NHS still offers a positive healthcare system. There are a lot of interesting datapoints including the fact that Britain only spent 6.3 per cent of its economy on government spending in the mid1990s and that we are 40 billion pounds short on spending.
One disappointment is the poor referencing system. Why can't books just use endnotes? For goodness sake! Other than this book is a good quick read on the challenges of the NHS.
April 27, 2024
I thought Free For All explains some of the problems the NHS is currently facing well, and that Dr. Francis suggests some very reasonable steps for improvement that could make great change in a system that is currently in great need.
Dr. Francis has valuable insight into many different aspects of how the NHS is ran as a GP, and it was important that a book of this nature touched on some of the struggles all healthcare professionals face. Free For All achieves this well, in my opinion.
As a healthcare professional in the NHS, Free For All has given me some food for thought regarding what can and needs to change to provide the best standards of care for our patients.
Dr. Francis has valuable insight into many different aspects of how the NHS is ran as a GP, and it was important that a book of this nature touched on some of the struggles all healthcare professionals face. Free For All achieves this well, in my opinion.
As a healthcare professional in the NHS, Free For All has given me some food for thought regarding what can and needs to change to provide the best standards of care for our patients.
August 18, 2023
I found this book really interesting. It’s full of statistics about the NHS and ways in which the service has changed over the years, highlighting the pressures on the NHS and suggesting possible ways to improve things.
I work for the NHS and the challenges that Dr Francis explains such as increasing pressures on GPs, poor retention of staff, low morale and increased waiting lists are things I see every day.
I work for the NHS and the challenges that Dr Francis explains such as increasing pressures on GPs, poor retention of staff, low morale and increased waiting lists are things I see every day.
December 21, 2023
A wonderful reminder of the importance of NHS in contemporary Britain and why it is on us to ensure its survival and thriving. Through political pressure and taking personal responsibility for one's health to ensure that each of us minimises our need to use it we can achieve that. The difference between NHS surviving and getting privatised could literally turn out to be a matter of life or death for us all. Let us hope that the society proves itself to be worthy of the miracle that is the NHS.
May 26, 2025
Gavin Francis provides an eloquent and relatable account of why primary care is so vital within a health system, and what could be done to improve a universal health system if policy-makers had courage and listened to those who understand the system’s failings. A doctor who still loves medicine but knows it could be done better.
December 28, 2025
I genuinely feel like everyone in the U.K. should read this book. It includes both powerful stories of the author’s experience as a GP and arguments on how we can make the NHS amazing again. I know I couldn’t live without it (and I’m forever grateful we have it).
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October 10, 2023so insightful and interesting, easy read
July 7, 2024
Perfect book to look behind the curtains of GPs and hospitals in the NHS - a must read before you comment on wait times, GP appointments etc.
September 17, 2024
Good insight into the inner workings of the NHS and why, even if at times it’s not working to its best, it’s worth saving.
September 30, 2024
Good read into issues in the NHS (although aware may be a bit biased)
October 11, 2024
This is really tough reading and heart-breaking for anyone that's been associated with the NHS over the last 15 years.
January 18, 2025
An important read
March 3, 2025
Excellent book. Bought at the Welcome Institute ( who published it) love this museum as well( in the heart if London)
April 18, 2025
An interesting, from-the-frontlines summary of what it feels like to be a GP in the NHS at this point in time. Didn't have as many suggestions as I was hoping on how to make things better.
Displaying 1 - 23 of 23 reviews