Friday, 4 July 2008

Our National Health Service – The Promise

One of my earliest postings on this blog; My Sweeping NHS Reforms concerned my fantasy reforms of the National Health Service - the majority of which I still stand by.

On the eve of the 60th Anniversary of its inception, I think about all the men, women and children born pre-5th July 1948 who were promised healthcare 'from the cradle to the grave' by the State and were given the NHS basically as national reward and recognition for the privations and suffering they endured through World War II, whether they be de-mobbed soldier, long-suffering civilian or evacuated child. That and the guilty fact that Joe Public got bugger all by way of national reward and the much-vaunted 'homes fit for heroes' after World War I.

It is doubly appalling to me when anyone from this generation is denied NHS drugs or care, not only on account of everything they went through during WWII whether adult or child to secure the future of this nation, but because they were promised this care, and the majority paid contributions all their working lives towards it.

I wonder why none of them (or their families if they are too ill themselves) has yet gone to the European Court of Human Rights to defend their right to this national promise made to them.

Glittering 'polyclinic' re-launches of the NHS butter no parsnips with me when layers of re-branding, management and unnecessary new PFI-disaster hospital buildings even less light, airy and value for money than the old (and just as dirty), divert money away from the sick who need it, and some of whom were born with a right to it.

When the pre-1948 generation pass from living memory, then will be the time to consider root and branch reform of the NHS if it does not find a natural and sensible balance between advances in medicine and over-demand in-between times, but not until.

Happy Anniversary NHS! Your days of being 'the envy of the world' may be long gone, but you were a good idea and can be so again if only the powers that be display some honour and common sense in the administration of your ministrations.

As the Hippocratic Oath that all new doctors used to have to swear before commencing practice puts it; 'First, do no harm.'

And not all medical advance is for the better…concrete fatigue is a terrible way to go!


Rol said...

I wasn't aware of the history behind the inception of the NHS... but that just makes the whole situation even more depressing!

Jock Coats said...

However, apropos of some of the arguments raging today about top-up treatments, I noticed when reading the Beveridge Report (the document that led to the NHS essentially) that one of the key principles was that any intervention should be a partnership between state and individual and the state's response, ie the NHS, should not stifle innovation and the ability to go one better than the "minimum" standard laid down by the state through individuals topping up.

There are ways of delivering that promise of "cardle to grave" to that generation whilst reforming or abolishing the NHS. Much of the cause of ill health is poverty or want, one of the other "great giants on the road to reconstruction" that was supposed to have been solved by the Beveridge report and the ince[ption in that case of the benefits system. The private capture of the rent from land is what underpins poverty. Get rid of that and distribute that value to everyone equally and they'd have a considerable financial cushion with which to make their own arrangements of their own chosing.


Piú giú, in fondo alla Tuscolana...!?...passavo per un saluto!

Steve said...

Compared to part of Europe, the UK is a joke. Our standard of living is crap, the nation's health is tragic and we all work far too many hours and are yet less productive than our European counterparts. It's about time we lost our snobbery of Europe and started emulating...

Old Fogey said...

I'm not sure that hospitals are any better than they were. I remember them in the 50s and 60s - regimented, beds in a line (like in 'Carry On Nurse'), men and women separated, but scrupulously clean and well ordered. But it may be that the great achievement of the early National Health wasn't hospitals but in vaccination and diet. We used to get statutory orange juice and milk at school. This eradicated rickets and TB and the heavy fat diet of my parents was replaced by roughage and bread and potatoes. But, of course, then we had a narrow view about what the Health service would provide from the cradle to the grave - it was simple, basic health care. Now the NHS is providing cosmetic and other lifestyle services that were never envisaged by the founders. We've expanded demand beyond capacity. It's time to set simple limits on what the NHS can and can't provide. Hard thing to do, of course.

Anonymous said...

My own experiences of the NHS have been good - frayed around the edges maybe - but certainly the quality of medical care was excellent.

But having worked a lot with NHS Trusts recently I have less faith in the management structures. Too much money is still being spent on admin and non-medical matters and it is not even as if the management and admin is effective and efficient. I do work for them because the pay is good - really they should have inhouse staff available to do the work they are paying me to do. It is not rocket science the stuff that I do and I am asked to do much the same thing again and again for different sections within the organisation. Not an effective use of public money at all.

The NHS does need some serious restructuring and we also need to face up to the fact that if we really want it to meet all the things that we have come to expect of it, we are going to have to cough up rather more in taxes than we do at the moment. And no-one wants to do that when they feel that the money is being squandered by inefficient administration.

Wisewebwoman said...

It becomes a huge unweildy beast, unfortunately. The original premise was so good and lean. similar problems here in Canada. I think the countries with universal health care should get together and hammer out what works, what doesn't and trim the bureacracy.

The Sagittarian said...

Another reason to stay healthy, but you are right. A lot of the hospickles are top heavy these days, admin this and that at the exopense of other services (or so it seems). Not much better here really, my friend had a 10 day stay in hospital while the whitecoats did this test and that, finally sent her home undiagnosed but still in pain so then they decided it must be in her head and sent her to a nut it turns out, she had a hernia. You would think SOMEONE would have found that a bit earlier eh?

The Poet Laura-eate said...

Rol, sadly people (governments in particular) seldom seem to place a lot of value on social history. If they did, perhaps they would not keep making so many mistakes and often repeating so many of the same mistakes down the decades.

Fascinating points Jock, and I did think about linking to your thought-provoking post (only decided it wasn't quite akin to what I wanted to focus on), so thanks for linking to it in the Comments. I think there is something to be said for the minimum service with top-up option, but afraid I cannot agree that the NHS has outlived its purpose. And in my Sweeping Reforms of the NHS' I outline many ways and means in which existing money and resources could be better used and directed for patient benefit.

Steve, much though I love a lot about America, I would not want a US-style healthcare system where some patients are forced to mortgage and lose their homes to pay for cancer treatment because they cannot afford (or quickly run out of) exhorbitant health insurance. Like yourself I would much rather we took pick 'n' mix inspiration of the best elements of our various European cousins re any NHS remodelling.

Old Fogey - all good points, but imagine how much better the NHS could (and should) be if it still had Matrons, time to feed and physcially nurse patients and cleanliness to prevent superbugs in addition to the undoubted medical advances of the last 60 years. And Sanitoriums were great places for patients to finish their recuperation before being packed off home. Many patients are sent home far too early now, subsequently to be readmitted with 'complications'and if they're really unlucky, to contract the superbugs they missed first time round!

RB, I'm guessing most of your involvement with NHS has been through pregnancy, where they do tend to excel, bar the shortage of midwives. That and non-standard illnesses that private healthcare cannot cope with and is not equipped to deal with, although provision and service quality varies widely around the country as we all know.

WWW - wise words as always - I don't know why this country is so reluctant to take inspiration from other countries about what works best. It is such a waste of money (and lives) not to. Misplaced pride perhaps.

A psychiatrist to treat a hernia Sagittarian? Well that's something for your friend to dine out on for at least several years! Thank goodness it was not a more serious illness they bungled diagnosis on. I hope she is feeling better now. Perhaps NZ needs to join with UK in learning from other countries too.

Jock Coats said...

I should say, I do not think it has actually "outlived its usefulness", just that it ought to have, and the fact that it hasn't already is testament to the failure of that "war on the five giants" that began sixty-five years ago. There is much yet to do to get to that stage, but in my opinion it would be the desirable end point, because it would mean that virtually everyone would have achieved a level of prosperity in which they could all afford to make their own choices about things as personal as health choices.