What is so good about the NHS? Part 2

History of the NHS

NHS established

Following the National Health Service act of 1946 the NHS was established on July 5 1948 by the post war Labour government, introducing universal healthcare paid for through general taxation. The move saw an end to the restriction of care to those who could afford it.

Prescription charges introduced

Prescription charges were introduced at one shilling (5p) as well as a flat rate of a pound
for ordinary dental treatment. Nye Bevan saw the introduction as a betrayal of the founding principles of the NHS. He and several of his colleagues, including future Prime Minister Harold Wilson resigned over the issue.

Smoking-cancer link established and daily visits for children in hospital introduced

Sir Richard Doll established a clear link between smoking and lung cancer. Doll promptly gave up smoking and he lived to be 92.

Before 1954 children in hospital were only allowed to see parents on Saturdays and
Sundays and were often placed on adult wards. Daily visits were introduced after Sir James Spence and Alan Moncriff demonstrated that separation from their parents was traumatic.

Polio and diphtheria vaccinations

In a major step forward for public health a programme to vaccinate everyone under the age of 15 against polio and diphtheria was introduced in 1958, meeting one of the NHS’s main aims of promoting good health.

The move sees instances of both diseases dramatically reduced.

First kidney transplant

On October 30th 1960 Sir Michael Woodruff and Mr James Ross performed the first UK
kidney transplant at Edinburgh Royal Infirmary involving a set of 49-year-old twins. Both the donor and recipient lived for a further six years before dying of an unrelated illness.

The Pill made available

1961 saw the introduction of the contraceptive pill, one of the most significant medical advances of the twentieth century. At first it was made available to married women only but was made more widely available in 1967, leading to sexual freedom for women.

The Hospital Plan and hip replacement

1962 saw the publication of the Porritt report, which results in the Conservatives' Hospital Plan. The report voices the concern of medics about the separation of the NHS into three parts – hospitals, general practice and local health authorities – and calls for unification. The 10 year Hospital Plan approves the development of district general hospitals for population areas of about 125,000.

In the same year the first full hip replacement was carried out by Professor John Charnley in Wrightington Hospital.

The Salmon Report

The Salmon Report sets out recommendations raising the status of nursing staff and developing a structure within hospitals.

The Cogwheel Report considers the organisation of doctors in hospitals and proposes speciality groupings.

Liberal MP David Steel’s private member’s bill became law as the Abortion Act in 1968.

First NHS heart transplant

In 1968 Frederick West became the first person in the UK to receive a heart transplant at
the National Heart Hospital in London led by Donald Ross. It was only the tenth time the
operation had been carried out since Christian Barnard led the first operation in South Africa in the preceding December. Today around 300 heart transplants are carried out yearly in the UK.

1972 - 1980
Introduction of new technologies

1972 saw Computer Tomography (CT) scans revolutionise examinations of the body. In
1980 Magnetic Resonance Imaging (MRI) uses magnetism and radio frequency waves to provide information about soft tissues such as the brain, producing detailed pictures of the area which make conditions such as brain tumours and MS easy to identify.

Keyhole surgery

The first successful instance of keyhole surgery is the removal of a gallbladder. It’s known as laparoscopic surgery, after the instrument that’s used to perform the surgery, a thin telescopic rod lit with a fibre optic cable and connected to a tiny camera which
sends images of the area being operated on to a monitor. The procedure will go on to be used for hernia repairs and removal of the colon and the kidney.

Black Report

The Black Report investigated the inequalities in healthcare which it linked to social background. It recommended that the material lives of those from poorer backgrounds be improved through benefits, information and schemes to improve housing and working conditions.

Aids health campaign

The eighties saw a new epidemic as a result of HIV and in 1986 the government responded by launching the biggest public health campaign in history to educate people of the threat. The campaign was bleak and shocking and included television adverts
and household leaflets with the phrase “Don’t die of ignorance”.

Breast screening is introduced

National breast screening was introduced in 1980 aiming to reduce breast cancer rates in
women under 50 by providing mammograms. Hand in hand with drug therapies this helped cut breast cancer by 20%. Since the programme rolled out 19 million women have been screened saving around 1,400 lives a year.

NHS and Community Care Act

The Community Care Act of 1990 stated that it was the duty of local authorities to assess
the needs of people for social care and support, making sure that the population received the care they were entitled to. It also saw the introduction of an internal market giving health authorities the power to manage their own budgets and buy healthcare.

The birth of the Private Finance Initiative

In 1992 the then Chancellor of the Exchequer, Norman Lamont formally introduced the Private Finance Initiative (PFI). The government believed that private financing in the building of NHS infrastructure would keep costs down and eliminate financial risk. Figures that emerged in 2007 showed that £53bn were being paid to the private sector while many hospitals faced debt crisis and the threat of cuts and closures.

NHS Direct launches

As part of New Labour’s NHS reform NHS Direct was launched in 1998 as a nurse led information service giving basic healthcare advice and re-directing those with more serious conditions. It provided a seven days a week, round the clock service.

The NHS Plan & ISTCs

By 2003 the government had selected seven private companies to run 24 fast-track surgery centres on five year contracts that would mainly concentrate on minor operations such as hip and knee replacements, cataracts and some diagnostics. Guaranteed contracts were given to private providers in the first wave where money would be paid regardless of how many procedures were carried out.

Foundation Trusts introduced and CHC’s abolished

Foundation Trusts arrived with the advent of the Health and Social Care (Community Health and Standards) Act 2003. Foundation Trusts that perform well can earn themselves greater autonomy and, critics say, better funding which can be at the expense of other Trusts, widening the gap between the best and worst. The same
year saw the abolition of Community Health Councils. Set up in 1974, the councils’ role was to monitor and review the NHS and to recommend improvements on behalf of patients. The councils would also give advice on how to access services as well as how to complain. CHC’s were replaced by PPI’s (Patient and Public Involvement Forums) in 2004.


Whatever happened to NHS glasses?

Everyone over a certain age remembers NHS glasses with their thick rims and their bronze wires curled behind the ears. To some people they will forever be a sign of poverty and the mere thought of them brings back a surge of playground embarrassment. But at least they were free, back in a time when the NHS paid for everything. Or is this just a rose-tinted memory?

The truth is that for many years the NHS has struggled with inadequate resources. The demise of NHS glasses – to the relief of small children everywhere – represents a wider problem in meeting growing patient demands. Gone are free eye tests and dental
treatment for the whole population. And in today’s NHS the service may not pay for an expensive new cancer treatment, or the cost of long-term care for your elderly relatives. In 1952 the introduction of prescription charges and a small charge for dentistry was the
first public acknowledgment of the tension between money in and money out and it is still evident today.

So what can you get for free now? Well a huge range of care is still available under the NHS, but you’d be hard-pressed to find a definitive list. So for the public it is very hard to keep track of how comprehensive the service really is.

Take drugs, for example, although they may be approved for safe use, it doesn’t mean the NHS will pay for them. That funding decision is made at the local level – in reality it is a decision based on affordability. This, as the media are so fond of pointing out, has led to the creation of a postcode lottery for some drugs, in particular expensive drugs, including ones to treat Alzheimer’s disease and cancer. NICE (National Institute of Health & Clinical Excellence) set up in 2004 to even out these discrepancies, may well then wade in to provide some guidance based on efficacy and that rather elusive aim of economic value. A positive recommendation from NICE is supposed to end any uncertainty or inequality over prescribing, however, a negative recommendation moves the decision back to the local level.

There is however a different way to get a free prescription on the NHS - you enlist the full force of the law and of course, the even mightier force of the media. If your story is appealing enough you might win local funding, but where does that leave patients in a similar position that the media doesn’t want to write about? Their protection must come through the accountability of the NHS and the chance of appeal or redress. Perhaps with the current fragmentation of the NHS into hundreds of competing businesses, this is where the public must demand urgent improvement.

When the NHS was founded there were no heart transplants, no magnetic resonance imaging and very few treatments for cancer. The NHS is definitely facing new challenges with the cost of drugs escalating, and the population growing ever greyer. But the NHS does still provide a huge range of care free at the point of use, if in the future there are hard choices, the public should have their say.


No teeth today, no NHS tomorrow

Forget polar bears, David Attenborough will soon be reporting on the NHS dentist such is its growing rarity. Recent research showed that more than 23 million people have not been to an NHS dentist for nearly two years. The impact will not only mean a decline in our general oral health but also a cut in the early detection of serious conditions like cancer, which can be picked up by your dentist.

This is a glimpse into the reality of healthcare funded by individuals and not shared. If you feel it in the pocket then many people will simply not access care even if they need it.

Like dentistry long term care costs are now often met by the individual. These patients have little option but to seek care and 40,000 people a year are forced to sell their homes to pay for it.

So should we accept that the NHS will have to cut back large areas of care and all buy health insurance? NOO!
This would be the final nail for the NHS. Healthcare is so important to our ability to live active and fulfilling lives that it must be a very high priority for public funding. Perhaps then it is about more of us getting more involved in the decisions about how our money is spent. All politicians say they support the NHS, but are there enough of them defending it?

The cost of healthcare is not just a problem in the NHS, it is rising across the globe. Look to the US and you see a healthcare system where 40 million have no health cover and where insurance companies employ people to refuse claims on health policies. US citizens
have nothing like the peace of mind that is offered by the NHS, yet they spend twice as much per head of population. The simple fact is that you have to pay for healthcare in one way or another, or go without. The NHS is still great value. If you believe that access to healthcare should be more a right than a privilege of wealth, we should all do what we can to ensure its future.


Back to the future - NHS plc

What on earth does it mean when you see the government launching this or that new policy for the NHS on the evening news? A minister (usually one you’ve never seen before) pops up on the TV, sounding very reasonable but using words that most people outside the NHS don’t understand. She says she wants to make things better for patients. Great, but then a doctor is interviewed saying the new scheme will do theopposite, in words that even fewer people understand. Then some health campaignercomes on saying it’s the end of the NHS as we know it, using a language absolutely no one understands. So you turn over to the Simpsons.

The debates around the health service can sound so technical that most people simply switch off and assume that everything will be all right, that the NHS will always be free and as much a part of Britain as Cornwall is. But this is not necessarily so – for example, just think how much you had to shell out last time you went to the dentist. Who would have thought it 20 years ago?

In fact the government is right in the middle of the biggest experiment with the NHS since it was founded in 1948. They are trying to make it more commercial, more like the private sector, and are using more companies to provide services.

The crazy thing about this approach is that the aspects of the NHS that were
considered its best qualities in the 20th century are the very features that are under
threat in the 21st. The reason why the NHS is regarded by the public as Britain’s most
valuable institution is because of what it says about us as a society – that no one should fear the financial cost of getting ill; that when someone’s health fails they can rely on the rest of us to help them through, just as they have helped others in the past. There is nothing as tall, nothing as proud as placing care of the sick before the pull of the pound.

But the government doesn’t seem to get it. It sees so many of us shopping in Tesco
and concludes that the thing to do is run the health service like a chain of supermarkets.
It has brought in a new financial system, called ‘payment by results’, which means that hospitals have to compete with each other for every penny. Some operations bring in more income, while others are barely worth the hospital doing at all. It’s not only complicated, it’s a more expensive way of running things. And what about the patient with a hernia who finds they can’t get the operation they need, because it’s no longer economic?

Coupled with this is the influx of private companies into the NHS. From private clinics being paid to do simple operations at rip-off prices, to giant corporations like Virgin taking over GP surgeries, there’s no doubt that something big is underway, and it looks a lot like privatisation.

In the UK, the word ‘private’ is still associated with efficiency, quality and even luxury, no matter how many times people are kept hanging on the phone by their internet provider or waiting in a queue at the bank. If Richard Branson’s company comes along and takes over your GP surgery, spruces up the waiting room and slaps a shiny logo above the door, what’s to worry about? He seems like a nice man anyway.

But no matter how you dress it up private companies are only interested in one thing:
profits. It’s not their fault, any more than a snake is to blame for being a poisonous,
cold-blooded reptile - it’s just the way they are. The question for patients is: do you want
to be treated by people who only have to answer for your health, or by people who
have to answer to shareholders?

When Gordon Brown came in many thought that the days of Tony Blair’s infatuation
with the private sector were over. But in fact he is accelerating the invasion of private companies into GP surgeries and primary care. And he has launched “Our NHS, our future” a review led by Lord Darzi aimed at changing the shape of the health

It looks like this will mean centralisation of some services, and a new breed of ‘polyclinics’ – part GP surgery, part hospital, part private health centre tempting you with extra services like physiotherapy, if you can afford them. The flip side is that many established hospitals and departments will be under threat. Even before the Darzi review has been completed many closures are underway, making a mockery of the expensive consultation exercises being carried out at your expense to get your view and then ignore it. Patients will inevitably be asking if the health service is really getting better, when they have to
travel twice as far to get to an A&E.

2008 is the 60th year of the NHS. It remains a beacon of humanity in a cruel world. But the current reforms are taking it in a new, uncharted direction. In the end it comes down to this: with these changes, will you be able to trust the health service of the future to put your care first? If you think not, you need to make your voice heard now.


Why we love the NHS:
A health worker’s perspective

Norma Stephenson is a healthcare assistant in the North East and has worked in the NHS for over 30 years. Norma also became UNISON President in July 2007.

“In my role working in the National Health Service I get to see things close up, at the sharp end. But sometimes it’s easy for all of us to take for granted just what a unique service the NHS provides.

“As someone who recently received treatment for a broken leg this gave me extra reason to be grateful for everything our health service does. You know that if things go wrong, if accidents happen – you have the security of the NHS to help you out.

“It is essential that those of us that work in the NHS and use the service continue fighting to protect its founding principles of fairness and equality that distinguish it from lesser systems.”

Elizabeth Barrett is a GP and worked in the NHS for 25 years. She is still very clear about her reason for working in the NHS.

“To work in a health system where people don’t have to pay for their care. To contribute to social solidarity. To minimise conflict of interest in health care. To be proud of the job I do. To bring health care to people who need it, but would not otherwise be able to afford it.

“I work in a deprived area. Services need to be free (I know that specs and dentistry aren’t, but we need to preserve a health service where people aren’t bankrupted by health costs). The main other feature is that we need to work in a system where, if we save money on patient care, we know it goes towards more patient care and not into profits for investors.”

Simon Jones (name changed) is a senior manager and works on service development, capacity planning and contracting.

“I have worked in the NHS for 12 years. I wanted a job that contributed something
to society, so I became a nurse. Professionalism of staff is paramount, but there can be a clash when national standards are imposed or worse still, management decisions are imposed. The use of the tariff system to control clinicians is immoral. The NHS is supposed to be a co-operative network but instead we have separate units who try to empire build, we have units competing against each other rather than working cooperatively.”

Dr. A.E. North is a Consultant Radiologist who has worked in the NHS for 38 years.

“At school my biology teacher thought I ought to try and be a doctor. I had lower aspirations but I am so glad I took his advice. At present freedom in clinical decision making is being eroded by financial pressures and government agendas. The professionalism which has been so important across the whole workforce has similarly been eroded. On the positive side I believe that all in our society can access health services and I have seen how investigating possible cancer patients in 2 weeks has benefited a lot of patients.”

Eleanor Smith is a Register Theatre Nurse in the West Midlands. She has worked for the NHS for over 20 years and stayed in the service after her training because she wanted to continue to make a difference and to help improve the health and wellbeing of her local community.

“The most important thing about the NHS is continuing to deliver first class care to all patients who come through the system.

“The NHS should always aim to be achieving the highest standards of care, through developing its staff and by putting patients and the public at the centre of all its decisions. The NHS should ensure that it delivers a service fit for purpose and continues
for the next 60 years and more.”


Key facts about the NHS

In the UK life expectancy is increasing by one year every four years. In 1950 life expectancy for people was 69.2 years. It is now 77.2 years and rising.

The NHS is the third largest employer in the world with around 1.3 million staff. This is 2.5% of the UK working population.

According to the latest workforce census, the NHS employs 386,400 nurses — matching the entire population of Edinburgh.

In 1948, when the NHS was founded, 11 per cent of the UK population was 65 or over; in 2008 that figure is 16 per cent.

In a typical NHS week 1.4 million people will receive help in their home from the NHS and more than 800,000 people will be treated in NHS hospital outpatient clinics.

In the 2006 Healthcare Commission in patient satisfaction survey 92 per cent of the 80,000 respondents rated the care that they received as excellent (41 per cent), very good (36 per cent) or good (15 per cent).


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