NHS Anniversary

Today we are celebrating the 75^th anniversary of the National Health Service, a key part of the Welfare State which we are led to believe was created by the post-war Labour government.

 

As the historian David Edgerton points out in his refreshingly different history, “The Rise and Fall of the British Nation," (Penguin 2019), the innovatory  character of this period is somewhat exaggerated. 

“. . .in the 1930s there already was  an elaborate system of welfare* for the [British] working class (that is about 80 per cent of the population) : all was ready for Sir William Beveridge [Liberal] to rationalize , and ‘by the legislation of 1945-8 the gaps were filled, the walls finished  and a roof put over all’” (pp 236/7).

 

This 75^th “birthday “ is seen by one and all as a time to take stock, assess the adequacy of its present performance, and suggest how it might be modified from a “national treasure" from the past to a service adequate for the future in which communications, medical technology, longevity and, indeed, expectations, are very different from the world of the 1940s.

One of the founding principles of the NHS is that it should be “free at the point of use.”  Last week a survey was published which claimed that the majority of people expected charges for its services to e imposed in the near future.    This seems an odd thing to start worrying about now.  Charges for spectacles, dentures and prescriptions were imposed within four years of the Service’s foundation,  (although for the majority of people, including children and the elderly, prescriptions are still free.)  So charges for other services, such as doctors’ appointments, hospital “hotel” costs, would simply be an extension of the existing system.  Indeed  dental services for most  are already largely privatised, and there are substantial charges even for those of us lucky enough to still be treated by an NHS dentist.  This trend is, in my view, in urgent need of reversal.

For many years the UK has trained insufficient doctors, nurses and other medical practitioners for domestic use.  Given that our medial, dentistry  and   nursing schools are still ”world class” we should be training a surplus for “export” to less developed countries.  Instead we have done the opposite, and “poached” staff from other countries, some of them the poorest,  desperately short of their own practitioners.  This is immoral and should be reversed.

Both doctors, now including consultants as well as “junior” ones, and nurses have been holding strikes for some time or are about to.  The headline demand is for more pay and is certainly justified for nurses.  For doctors I’m not so sure.  The “screw” of a consultant is said to be over £120 000 a year, which seem a lot to me, and something for the "juniors" to look forward to.  However, what is critical is their working conditions.  Because of shortages all medical staff are working under considerable pressure and leaving the profession in droves, which make a mockery of attempts to increase the training of replacements.  Our government claims to believe in ”market forces.”  Measures, including both pay and conditions, need to be taken so that those attracted to the service stay in it.**

Along with the pressures of overwork are the frustrations arising from inadequate buildings and outdated and malfunctioning technology.  These areas have been starved of funds for years and particularly since the post 2010 “austerity.”  Government spokespersons talk glibly of reforms of organisation, which they presume to be cost-free.  Maybe, but costly updating of capital is essential.

There are strong calls, including from Sir Tony Blair, our former Labour prime minister, for an expansion of the private sector to help plug the gaps.  It is  a credible supposition that the NHS has been deliberately starved of funds by the Conservatives, in order to facilitate this trend.  There is little doubt that the likes of American hedge funds are salivating to get their hands on greater chunks of the service.  I believe this should be resisted.

 International comparisons of health outcomes show that the UK is about average  in the pantheon of rich developed countries.  We are certainly not the “best in the world “ or “ the envy of the world.  This modest showing is not entirely the responsibility of the NHS.  Health outcomes are also determined by the quality of housing, diet (Mediterranean being much healthier than pie and chips), education, opportunities and equality.

 So what should we do?

Certainly the structure of the NHS may need reform.  My own view is that  rather than a “national” service, responsibility should be devolved to  democratically controlled regions.  A post-code “ lottery” does not worry me, provided that priorities are democratically determined.  Whatever reforms are suggested should be generated by experienced practitioners and patients, not by managers and certainly not by politicians.

We should put more resources into prevention – public health.

We need to integrate care services into the mix.

We need to reverse privatisation.

We need to pay more in taxes to finance a health service  fit for the next 75 years.

 

* This pre- war welfare provision included medical services.  I can't find the details via Google, but most families belonged to a "Panel," some form of insurance related to employment, in which access to doctors was either free or  for a token payment. The "cover" included hospital treatment.  After a road accident in 1944 I spent a month in the local hospital and as far as I know my parents didn't pay a penny.  The 20% whom Edgerton admits missed out were probably those where no-one in the family was in employment; probably single women and widows.  The post war government filled these gaps. 

** A similar situation exist in teaching, where more that one in ten new teachers quit in their first year, and more than a third within their first six years.