What do you think?
Rate this book
Fighting for Life: The Twelve Battles that Made Our NHS, and the Struggle for Its Future
'The book the NHS has always deserved' Andrew Marr
'A sensational and much-needed book . . . thorough, scholarly and above all readable' Chris van Tulleken
--------------------------------------------------
How does our National Health Service really work, and what does that mean for our future?
Since its foundation in 1948, the NHS has come to define our national identity, making history (and the headlines) again and again - from cutting edge discoveries like the first 'test tube baby', to its heroic response to the Coronavirus crisis. But the NHS has also become a battleground for some of the fiercest political contests of our time, perceived either as a national treasure, or as a lumbering piece of state machinery in need of renovation.
In Fighting for Life, bestselling journalist Isabel Hardman cuts through the sentimentality and sloganeering on all sides of the political spectrum. Packed with gripping stories from the people at the beating heart of this venerated institution - its nurses, its doctors, its patients and the politicians who decide its fate - this is the essential book for understanding our NHS, and who we are as a nation.
'A sensational and much-needed book . . . thorough, scholarly and above all readable' Chris van Tulleken
--------------------------------------------------
How does our National Health Service really work, and what does that mean for our future?
Since its foundation in 1948, the NHS has come to define our national identity, making history (and the headlines) again and again - from cutting edge discoveries like the first 'test tube baby', to its heroic response to the Coronavirus crisis. But the NHS has also become a battleground for some of the fiercest political contests of our time, perceived either as a national treasure, or as a lumbering piece of state machinery in need of renovation.
In Fighting for Life, bestselling journalist Isabel Hardman cuts through the sentimentality and sloganeering on all sides of the political spectrum. Packed with gripping stories from the people at the beating heart of this venerated institution - its nurses, its doctors, its patients and the politicians who decide its fate - this is the essential book for understanding our NHS, and who we are as a nation.
377 pages, Kindle Edition
Published June 22, 2023
34 people are currently reading
403 people want to read
About the author
Isabel Hardman
15 books53 followersIsabel Hardman is a political journalist and the assistant editor of The Spectator. In 2015, she was named Journalist of the Year at the Political Studies Association's annual awards.
She is the daughter of Michael Hardman, the first chairman and one of the four founders of the Campaign for Real Ale. She attended St Catherine's School, Bramley, and Godalming College, before graduating from the University of Exeter with a first class degree in English Literature in 2007. While at university, Hardman worked as a freelance journalist for The Observer. She completed a National Council for the Training of Journalists course at Highbury College in 2009.
Hardman began her career in journalism as a senior reporter for Inside Housing magazine. She then became assistant news editor at PoliticsHome. In September 2014, GQ magazine named her as one of their 100 most connected women in Britain, and in December 2015, she was named "Journalist of the Year" at the Political Studies Association's annual awards. She is currently the assistant editor of The Spectator, and writes a weekly column for The Daily Telegraph.
She appears on television programmes such as Question Time, This Week, The Andrew Marr Show and Have I Got News for You, and is a presenter of the BBC Radio 4 programme Week in Westminster.
She hosts The Spectator Podcast.
She is the daughter of Michael Hardman, the first chairman and one of the four founders of the Campaign for Real Ale. She attended St Catherine's School, Bramley, and Godalming College, before graduating from the University of Exeter with a first class degree in English Literature in 2007. While at university, Hardman worked as a freelance journalist for The Observer. She completed a National Council for the Training of Journalists course at Highbury College in 2009.
Hardman began her career in journalism as a senior reporter for Inside Housing magazine. She then became assistant news editor at PoliticsHome. In September 2014, GQ magazine named her as one of their 100 most connected women in Britain, and in December 2015, she was named "Journalist of the Year" at the Political Studies Association's annual awards. She is currently the assistant editor of The Spectator, and writes a weekly column for The Daily Telegraph.
She appears on television programmes such as Question Time, This Week, The Andrew Marr Show and Have I Got News for You, and is a presenter of the BBC Radio 4 programme Week in Westminster.
She hosts The Spectator Podcast.
Ratings & Reviews
Friends & Following
Create a free account to discover what your friends think of this book!
Community Reviews
Displaying 1 - 27 of 27 reviews
November 18, 2023
interesting critique of the NHS from its pre 1948 stirrings to post 1948 and its many battles challenges through various Governments to modernise adapt and the scale of things. overall informative and objective view of the NHS
August 31, 2023
This book is not a history of the NHS but chronicles 12 struggles that have taken place in its 75 years.
The NHS literally sprang up overnight. One day it was not there, the next day it was. It began in a world where nearly all men and many women smoked, and few were obese (difficult on war rations).
Very early on the huge cost of the NHS became an issue, and established the tradition of the Health Secretary asking the Treasury for more money. Prescription charges were introduced to help pay the bills, and tobacco duty was sorely missed as people started to give up smoking (or died from it).
We hear of societal changes that had to be absorbed into the NHS - the pill, legal abortions and medical developments such as heart transplants and IVF.
As new hospitals were built the management of them became a larger issue. We hear of a bewildering series of re-organisations and much talk of "command and control". The Tories brought in Internal Markets, which New Labour scrapped but brought in targets and metrics, which continue to this day to be gamed.
Then there is the dark side of the NHS. Health issues like MRSA, Aids and Covid. Shipman barely gets a mention, and Letby came after publication. The pair both flourished under the NHS, which should have flagged up the huge spikes in deaths in patients close to them. Not easy with the paper records, printers and fax machines that still power the NHS.
Finally, there is the future which looks bleak (but then it always has). The cost of looking after our old, obese population is a hugely different challenge to the thin, young people of the 1940s, yet the NHS remains - running in parts on technology that is decades old. It is still widely regarded by the British public, apparently.
The 12 chapters of this book tell a tale of perpetual struggle, and lots of old squabbles are unearthed in it. There has rarely been a time when the NHS hasn't been in crisis. Probably every issue has been seen before - history in the NHS repeats itself too. If there is a theme to the book, it is that somehow this much-loved behemoth adapts against all the odds.
The NHS literally sprang up overnight. One day it was not there, the next day it was. It began in a world where nearly all men and many women smoked, and few were obese (difficult on war rations).
Very early on the huge cost of the NHS became an issue, and established the tradition of the Health Secretary asking the Treasury for more money. Prescription charges were introduced to help pay the bills, and tobacco duty was sorely missed as people started to give up smoking (or died from it).
We hear of societal changes that had to be absorbed into the NHS - the pill, legal abortions and medical developments such as heart transplants and IVF.
As new hospitals were built the management of them became a larger issue. We hear of a bewildering series of re-organisations and much talk of "command and control". The Tories brought in Internal Markets, which New Labour scrapped but brought in targets and metrics, which continue to this day to be gamed.
Then there is the dark side of the NHS. Health issues like MRSA, Aids and Covid. Shipman barely gets a mention, and Letby came after publication. The pair both flourished under the NHS, which should have flagged up the huge spikes in deaths in patients close to them. Not easy with the paper records, printers and fax machines that still power the NHS.
Finally, there is the future which looks bleak (but then it always has). The cost of looking after our old, obese population is a hugely different challenge to the thin, young people of the 1940s, yet the NHS remains - running in parts on technology that is decades old. It is still widely regarded by the British public, apparently.
The 12 chapters of this book tell a tale of perpetual struggle, and lots of old squabbles are unearthed in it. There has rarely been a time when the NHS hasn't been in crisis. Probably every issue has been seen before - history in the NHS repeats itself too. If there is a theme to the book, it is that somehow this much-loved behemoth adapts against all the odds.
December 25, 2024
A wide ranging and excellently researched book that both explores and implores change in the health service. The book is deeply interesting and learning the lessons of yesterday are vital for the delivery of health care into the future.
June 26, 2025
A compelling, well written, expertly researched & always relevant insight into the challenges facing the NHS.
January 30, 2025
Depressing read. Continous culture of the two main political parties blaming each other for the failing of the nhs. Endless cycle of health secretaries beliving their 'unique' ideas will save the nhs when really they add increasingly complicated legislation and make it harder for the staff to give patient care. Does not give hope for a promising future for the nhs.
Chapter 8 about the AIDS pandemic and the blood infected scandal was profound. The Mid Staff and Morecambe Bay scandals are disgusting and heartbreaking to hear. The authorities, NHS and government coverup enrages me.
Chapter 8 about the AIDS pandemic and the blood infected scandal was profound. The Mid Staff and Morecambe Bay scandals are disgusting and heartbreaking to hear. The authorities, NHS and government coverup enrages me.
July 29, 2023
This year is the 75th anniversary of the NHS, so naturally a few books have been published to commemorate the occasion. Hardman's 'Fighting for Life' is a pop history of the institution, framed around 12 battles which shaped the NHS into what we have today. I would recommend it, with caveats, to those who work in or with the NHS, or use its services regularly.
I found it an enlightening reading experience which helped me contextualise my working life into the story of the NHS. Hardman is a political journalist - her previous book, 'Why We Get The Wrong Politicians', is excellent and one I include in my canon of 'Books That Exacerbated My Disillusionment With British Politics - but this means her NHS book is largely focused on the political personalities and arguments within government and parliament about NHS reforms. While I personally was engrossed (in another life I could imagine myself as a policy wonk), I imagine many people would find this political focus quite boring, especially if they don't go into the book with some pre-existing knowledge about UK politics.
The NHS is a political football; Hardman deftly shows the various ways all political parties have, often hypocritically, attacked each other over the NHS. She explores the realities and misunderstandings behind the fear, present since the inception of the service, that there is a secret plot to dismantle or privatise the NHS, and replace it with an American-style system. Like any good conspiracy theory, there are grains of truth to it: a small faction of the Conservative party does admire the American system, but are aware that going down that route in Britain would be political and electoral suicide on a truly colossal scale.
Politicians are often frustrated that popular political discussions about healthcare in Britain are framed around, and therefore extremely limited by, the false dichotomy between the state-run NHS model and the American-style private hellscape, ignoring the myriad other ways that countries fund and manage their healthcare. Both Labour and Conservative governments have increased private sector involvement in the NHS and added charges, though Labour tends to get away with it because they are more trusted on the NHS.
Across the 12 battles, which range from early arguments over whether there should be an NHS and how it should be structured and funded, through many reforms and modernisations, to the COVID pandemic and the many crises that face the post-pandemic service, we learn about the origins of prescription charges and CQC inspections; the uses and abuses of performance targets; why maternity units are particularly scandal-prone; the growth of the culture of cover-ups, bullying and blame; the many arguments between Health Secretaries and Chancellors over funding; and much, much, much more.
The picture that emerges is of a vast, complex, bureaucratic system that is slow to change but has changed so much. A service which very few people even begin to understand, even as they claim to adore it. An institution that is extremely impressive and successful, but creaking, straining, and intensely suffering from deep seated problems exacerbated by recent systemic shocks.
The final chapter ends with an attack on the shallowness of current NHS discourse, and a call to action for someone, or several someones, to actually do something about it:
'There has been enough lovebombing from politicians too fearful or lazy to confront the truth about the state of the service and what it needs. Now, it needs someone who knows what they are really fighting for. Depending on how well they fight, it could either be the latest or the last battle of the NHS's long struggle to exist'.
I found it an enlightening reading experience which helped me contextualise my working life into the story of the NHS. Hardman is a political journalist - her previous book, 'Why We Get The Wrong Politicians', is excellent and one I include in my canon of 'Books That Exacerbated My Disillusionment With British Politics - but this means her NHS book is largely focused on the political personalities and arguments within government and parliament about NHS reforms. While I personally was engrossed (in another life I could imagine myself as a policy wonk), I imagine many people would find this political focus quite boring, especially if they don't go into the book with some pre-existing knowledge about UK politics.
The NHS is a political football; Hardman deftly shows the various ways all political parties have, often hypocritically, attacked each other over the NHS. She explores the realities and misunderstandings behind the fear, present since the inception of the service, that there is a secret plot to dismantle or privatise the NHS, and replace it with an American-style system. Like any good conspiracy theory, there are grains of truth to it: a small faction of the Conservative party does admire the American system, but are aware that going down that route in Britain would be political and electoral suicide on a truly colossal scale.
Politicians are often frustrated that popular political discussions about healthcare in Britain are framed around, and therefore extremely limited by, the false dichotomy between the state-run NHS model and the American-style private hellscape, ignoring the myriad other ways that countries fund and manage their healthcare. Both Labour and Conservative governments have increased private sector involvement in the NHS and added charges, though Labour tends to get away with it because they are more trusted on the NHS.
Across the 12 battles, which range from early arguments over whether there should be an NHS and how it should be structured and funded, through many reforms and modernisations, to the COVID pandemic and the many crises that face the post-pandemic service, we learn about the origins of prescription charges and CQC inspections; the uses and abuses of performance targets; why maternity units are particularly scandal-prone; the growth of the culture of cover-ups, bullying and blame; the many arguments between Health Secretaries and Chancellors over funding; and much, much, much more.
The picture that emerges is of a vast, complex, bureaucratic system that is slow to change but has changed so much. A service which very few people even begin to understand, even as they claim to adore it. An institution that is extremely impressive and successful, but creaking, straining, and intensely suffering from deep seated problems exacerbated by recent systemic shocks.
The final chapter ends with an attack on the shallowness of current NHS discourse, and a call to action for someone, or several someones, to actually do something about it:
'There has been enough lovebombing from politicians too fearful or lazy to confront the truth about the state of the service and what it needs. Now, it needs someone who knows what they are really fighting for. Depending on how well they fight, it could either be the latest or the last battle of the NHS's long struggle to exist'.
June 17, 2025
Isabel Hardman is a critical friend to the National Health Service in this well-considered linear history. Rather than 12 clear 'battles', her account is one of grappling - by politicians, administrators, patients, and their families - with what a service free at the point of need should provide over the past 75 years.
Hardman repeatedly returns to the unhelpful characterisation of the NHS as both ‘national religion’ and political football. The Conservatives have never quite shaken off the accusation that they seek to dismantle it. Meanwhile Aneurin Bevan’s ghost haunted Labour ministers, from Barbara Castle in her crusade to eliminate elitist ‘pay beds’ to Alan Milburn’s controversial if pragmatic belief that private outsourcing was essential to curb spiralling costs. This tension lies at the heart of Hardman's story. Contrary to Beveridge and Bevan’s conviction that health costs would decline as conditions were progressively treated, the opposite has proven true: the NHS has become a fiscal black hole, as more diseases are discovered, more treatments developed, and lifespans extended - ushering in the chronic ailments of an ageing population.
Following the Covid-19 pandemic, this source of national pride has become a behemoth: its staff underpaid, underresourced, and burdened with waiting lists approaching 10 million. Through a historical lens, the NHS appears to have muddled through crisis after crisis for three-quarters of a century. But to view its current predicament in the same light, as commentators are wont to do, is to underestimate the scale of the challenge it now faces.
Hardman repeatedly returns to the unhelpful characterisation of the NHS as both ‘national religion’ and political football. The Conservatives have never quite shaken off the accusation that they seek to dismantle it. Meanwhile Aneurin Bevan’s ghost haunted Labour ministers, from Barbara Castle in her crusade to eliminate elitist ‘pay beds’ to Alan Milburn’s controversial if pragmatic belief that private outsourcing was essential to curb spiralling costs. This tension lies at the heart of Hardman's story. Contrary to Beveridge and Bevan’s conviction that health costs would decline as conditions were progressively treated, the opposite has proven true: the NHS has become a fiscal black hole, as more diseases are discovered, more treatments developed, and lifespans extended - ushering in the chronic ailments of an ageing population.
Following the Covid-19 pandemic, this source of national pride has become a behemoth: its staff underpaid, underresourced, and burdened with waiting lists approaching 10 million. Through a historical lens, the NHS appears to have muddled through crisis after crisis for three-quarters of a century. But to view its current predicament in the same light, as commentators are wont to do, is to underestimate the scale of the challenge it now faces.
March 27, 2024
A sweeping, chronological history of the NHS told through the lens of politics and government. Hardman does a very good job of maintaining a neutral perspective on the service, showcasing its successes, highlighting its failings and laying out the basic political dilemma its existence creates for governments of varying colours. The section on Covid was particularly strong and remained focussed despite the breadth of things she could’ve talked about.
I do think that her emphasis on the service’s resistance to change does ignore the desire of frontline staff for reform. As much as there is resistance higher up the food chain (it is an independent body after all) my experience working closely to the service is that doctors and nurses see the problems and want changes to be made - but enacting those changes is prevented by political blocks.
Enjoyed the book overall though and Hardman is an excellent writer.
I do think that her emphasis on the service’s resistance to change does ignore the desire of frontline staff for reform. As much as there is resistance higher up the food chain (it is an independent body after all) my experience working closely to the service is that doctors and nurses see the problems and want changes to be made - but enacting those changes is prevented by political blocks.
Enjoyed the book overall though and Hardman is an excellent writer.
February 13, 2024
A really great overview of the history, politics and disputes regarding the NHS in England with engaging writing. I only wish Hardman had been more bold in suggesting her own solutions to the problems identified at the end of the book as she calls for a radical approach towards the future. There were also a few points at which I wish more detail had been given to the presenting issue, as I found some interesting topics to be picked up and then dropped too quickly without a full exploration. For example, it is clear Hardman had very interesting conversations with the politicians, healthcare workers and patients yet very little of their conversation was discussed Nonetheless, this was a very interesting read and I enjoyed the political and historical commentary mixed with the modern challenges and disputes.
September 27, 2024
Did I read the same book as everyone else? I found this a fairly superficial overview of some moments in NHS history, more interested in the political personalities involved and their political challenges than the substance of the NHS's problems and reforms. The book never really deals with some of the core issues that beset the service, for instance its lack of focus on the health of the population rather than illness in individuals. Prevention gets a cursory few pages near the end, but this only mentions doing medicine a bit earlier rather than the need for work across government to empower communities to be well through things like tackling poverty and inequalities. For example, the fact that public health was taken out of the NHS in England in the Lansley reforms and its budgets decimated is not deemed worthy of mention.
Some interesting nuggets but I felt it missed the point.
Some interesting nuggets but I felt it missed the point.
October 7, 2024
Wow. This is a phenomenal albeit sobering read. The NHS is a national religion, beloved, with hardworking staff who go above and beyond, but is capable of appalling errors and cover ups. This is a powerful history of the service’s chequered history and a call for us to let go of some of the ideals and really reform the system with much greater emphasis on mental health, public health (especially obesity) and social care, less on training illness. Let’s hope our new government will be up to the challenge
August 23, 2023
Pretty thorough survey of the history of the NHS from it's founding to the covid era. The writer is a spectator journalist so I was a bit worried she was going to make a lot of policy suggestions about how we should just sell it all off to American insurance companies or whatever but she sticks to the chronology and only does the "lol, it's the closest thing the English have to a religion" 8 or 9 times.
December 27, 2023
Thank you to Penguin Random House for the early reading copy.
I thought Why We Get the Wrong Politicians was a great book so was very excited to read this book about the history of the NHS, told through twelve events.
Unfortunately though this book left me relieved that I'd finally finished it and made it through. There were some interesting highlights (the chapters on Covid and HIV) but the political angle made it a dry read.
I thought Why We Get the Wrong Politicians was a great book so was very excited to read this book about the history of the NHS, told through twelve events.
Unfortunately though this book left me relieved that I'd finally finished it and made it through. There were some interesting highlights (the chapters on Covid and HIV) but the political angle made it a dry read.
July 10, 2023
Hardman is a brilliant journalist, who is able to make complex topics simple and exciting. But even she struggles to make a book largely centered on NHS reform policy wholly entertaining. When the book is focused on the patients (e.g. HIV) it comes alive. But it is often a bit of a snoozefest.
July 12, 2023
A very interesting and comprehensively written account of the NHS, educating me greatly on the 12 ‘fights’ that have made it what it is today, and gives us clues towards its future. She was also so nice to interview!
September 25, 2023
Very readable and informative account of the setting up and history of the NHS and the challenges facing the NHS now. I found this really helped me understand what lay behind so many of the recent reforms.
July 24, 2024
A great accessible history of the NHS. Told without partisan views either way, if you want an account of all that is good and not so good about the NHS in the UK and to be more informed, it’s a great read.
July 26, 2023
Absolutely fascinating journey through time following the NHS. Another classic book from Isabel Hardman, superbly written, full of empathy, compassion and honesty. Highly recommended to all
September 16, 2023
Reads like 12 separate accounts of struggles the NHS has faced rather than a cohesive whole
December 25, 2023
A very interesting read, with fascinating insights.
March 20, 2024
A really nicely written and enthralling exploration of the history of the NHS, and the formative events that have shaped what the NHS is today
April 17, 2024
A smart, sympathetic but frank chronicle of the troubled history of the NHS that isn't afraid to highlight its shortcomings and failures, as well as its triumphs
June 29, 2025
4.5 stars
July 6, 2025
Well researched and well articulated detailing the trials and tribulations of the NHS. The chapters were very long, so it was a lengthy read.
October 27, 2023
Anyone who has worked in the NHS over the last few years , then you maybe able to live again through these chapters. The advent of Fundholding GPs, Andrew Lansley’s chaotic England NHS re disorganisation. Jeremy Hunt looking for a role as NHS didn’t have an appetite for yet another reorganisation, decided to address safety. But how did he really think that taking on junior doctors and provoking strikes would help, wasn’t he advised safety was different at weekends as sicker patients were around at weekends. Though a careful write up of various ‘scandals’ from Morecambe Bay to Stafford. Also chapters on AIDS epidemic, and discussing whether the NHS will continue in current form . Perhaps an updated edition should include the COvid-19 enquiry, the consultants 2023 strike , and perhaps a change of government in 23 or 24. Recommended? Yes 5/5
September 14, 2024
As an NHS worker I found this book really interesting although I did have to ask myself what we have learnt over the years and the challenges.
August 19, 2023
I really enjoyed Hardman's last book, but was disappointed this time.
The book is a potted history of the NHS, the final half of the book is very familiar material to anyone who had followed political news for the last decade. I was expecting more analysis, the lack of which resulted in a progressively boring read.
The book is a potted history of the NHS, the final half of the book is very familiar material to anyone who had followed political news for the last decade. I was expecting more analysis, the lack of which resulted in a progressively boring read.
Displaying 1 - 27 of 27 reviews