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Rapid Responses: Rapid Responses published:
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NHS at 60 - Ageing well or signs of serious Chronic Disease?
- John J Turner (31 May 2008)
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NHS Celebrates 60 Years
- Umesh Prabhu (1 June 2008)
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Origins of the NHS
- stephen mccabe (3 June 2008)
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Time to retire, and let younger generations take over ?
- L Sam Lewis (6 June 2008)
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John J Turner, Consultant Physician University Hospital Aintree Liverpool L9 7AL
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Free at the point of delivery [1] is simply not true for millions of lower paid families struggling to pay for prescriptions while much larger numbers of people more able to pay receive them free. Bevan would hardly regard this as a socialist ideal nor would he be content with the deteriorating access to NHS dentistry and a policy of categorising high dependency long term nursing care for the most vulnerable as chargeable social care funded from forced sales of homes. Some core services of the NHS and notably the emergency medical admission system are suffering long term over heating with too frequently intolerable levels of pressure leading to excessive bed occupancy, overcrowded wards, compromised infection control [2] and systematic breaches of privacy and dignity. The underlying pressures have been compounded by multiple underperformance in the delivery of improved community services and damaging errors in medical training epitomised by the MTAS failure. Mixed sex bays in Medical Assessment units are accepted as inevitable with Trusts offered a convenient loophole. Will the newly appointed NHS Dignity Ambassador [3] Sir Michael Parkinson be politically briefed and restrained or will we see him act in character and achieve his pledge to make ‘a real difference’ to dignity in NHS care. Patients coming through the emergency admissions service have little or no choice [4] making it essential that these services are of the highest standard. In contrast the high risk experiment of the largely untested Payment by Results financial regime is diverting crucial investment away into other services providing a strikingly higher specification of clinical environment. The 60th birthday party celebrations must be tempered with some serious analysis of just what are the first priorities of a publicly funded service. 1. Delamothe T. NHS at 60, Founding Principles BMJ 2008;336:1216 2.The Healthcare Commission Report. Investigation into outbreaks of Clostridium difficile at Maidstone and Tunbridge Wells NHS Trust: October 2007 3 BBC Health News; May 20 2008 4 Turner JJ NHS Reform: the problems are more than skin-deep; The Times Feb 2 2007 Competing interests: None declared |
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Umesh Prabhu, Consultant Paediatrician The Pennine Acute Hospitals NHS Trust, Bury BL97TA
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Sixty is a funny age! One can retire at 60, people look up to you as elderly statesman (hope I won't be criticised for being ageist) and one gets concession for travelling and one is fondly called as 'Senior citizen' and makes us realise that we are getting old in life! Has NHS reached that state and is it the time for NHS to retire? Of course not! I still passionately believe that NHS is the great Institute we have and collectively we should nurture it and make sure that it goes from strength to strength and celebrate another sixty years. Its founding principles are its strength and irony is that these same principles are its weakness as well. Free at the point of delivery, so no one cares how much it really costs? No one gives a damn as to how much money is being wasted, patients failing to attend their appointment costs nearly £150 Million, wasted antibiotics probably cost £150 million, wasted and unused medication another £400 million, MRSA, medical errors and so on costs much more and what a waste of money! It is funded by the central taxation so everyone thinks it belongs to them. Politicians, managers, doctors, nurses, patients, public and media; everyone is a stakeholder so everyone has an opinion about it and sadly most of them are very negative and most stories published in media are very negative. Doctors bashing a pass time for many journalists. We hardly see any positive or good news about NHS. Opposite party (irrespective of which party it is) use it as a political pawn to bash it and undermine it to score political points! What a sad irony! Time has come for us all to be proud of this great institute and be positive about it, talk about the good things about NHS, the good quality of care it provides to many millions of our patients, celebrate the dedication of many thousands of staff who works hard providing that good quality care day and night. It is our NHS and it belongs to all of us and it deserves to be treated with respect and let us all be very proud of this great institute and make sure that it goes from strength to strength, doing what it does best. But of course we got to make sure that we do continue to improve the quality that we provide to our patients so that we all can be very proud of this great institute. I sincerely hope any further NHS reforms will be done jointly by everyone who values this great Institute and takes pride in it. Competing interests: None declared |
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stephen mccabe, GP Principal Portree Medical Centre, Portree, Isle of Skye IV51 9PE
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Dear Sir, It is sad that yet another review of the origins of the National Health Service(NHS)in the United Kingdom makes no mention at all of the Highlands and Islands Medical Scheme(HIMS). Lloyd George's insurance scheme was aimed at those in employment who were earning no more than £160 per annum. It soon became clear that such as scheme was completely ineffectual in providing health care to the Highlands and Islands of Scotland where most bread winners were poor self-employed crofters and fishermen. These areas were grossly under-doctored because in many places it was impossible for the doctors to make an income. A committee, the Dewar Committee, was established to look into this anomaly. The Committee reported in 1912 and based on its recommendations the HIMS was established in 1913. This aimed to provide doctors for remote communities by guaranteeing their income so that they didn't have to rely on patient fees. It also established the network of community nurses complete with bicycles and nurses' cottages. Futher more it secured and developed remote rural hopsitals. Whilst not all of the Dewar recommendations came to fruition (and there was a degree of inconsistency with those that did) it is true to say that HIMS is widely seen as a forerunning model of the NHS. Its recurring exclusion from histories of the NHS is is yet another example of the institutional neglect that the Highlands and Islands have been subjected to for centuries. Yours faithfully
Competing interests: None declared |
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L Sam Lewis, GP Surgery, Newport, Pembrokeshire, SA42 oTJ
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Delamothe ably describes as founding principles some key NHS "genes" ( Universality, free-at-point-of-use, equity, central funding). He traces the parents (PoorLaw, Lloyd George) that conceived the NHS, and describes the long gestation (the inter-war organogenesis) and birthing pain (the War), and the birth attendants ( Beveridge and Bevan). The baby grew up strong despite a poor diet and environment, having to work hard for its living from the start. At 60 , it is time that all hard-working people were allowed to retire. It is the great folly of many Revolutionary Leaders to hang on too long. Let the bright young things take over ! Our NHS farm is now effectively divided between the four children ( England, Ireland, Scotland, Wales), who are all developing separately, and experimenting with their different blends of the founding genes. We have abolition of charges in Wales, and a battle for co-payments in England; an private- finance mantra at the DoH, and public service integration in N.Ireland (and Eire a lost twin ? ). Nobody is burying their talents. Very soon we should see which of the kids is making a success of it .. Lets hope they all do well ! Competing interests: I am a GP in Wales |
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