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The NHS at 50

BMJ 1998; 317 doi: (Published 04 July 1998) Cite this as: BMJ 1998;317:0

“How is the NHS doing?” somebody asked me in Kenya last week. It's a question I dread. “Well,” I start, “it all depends whom you ask….” This BMJ to mark 50 years of the NHS shows that questions on what it has done and where it is going are no easier to answer—but we have lots of views, many full of passion (p 9).

Aneurin Bevan, who created the NHS, said that Britain was doing “the most civilised thing in the world,” putting “the welfare of the sick in front of every consideration.” Julian Tudor Hart thinks the NHS represents a deep collective ideal (p 1), while Nick Timmins reminds us that its birth was accompanied by “the biggest single tranche of welfare state reconstruction that the UK has seen” (p 2). Fifty years on most of the other reforms are fading. David Morrell gives an insider's account of developments in general practice (p 40), while Charles Webster, the NHS's historian, looks at the fraught relationship between the NHS and the BMA (p 45). Michael Portillo, a leading right wing politician, argues that Bevan created such a mythology for the NHS that he has made later politicians terrified of fundamental reform (p 37).

The view of the NHS from abroad is mixed. Austrian doctors see it as a nightmare, while health service researchers think of it “as one of the most exciting and successful attempts organised by government to deliver a scarce and crucial societal resource in a rational, communal, and civilised way” (p 48). Norway (p 49) and New Zealand (p 53) generally approve, Australia is becoming more interested as it begins another round of healthcare reform (p 55), but Singapore—which spends only 3% of its gross national product on health and has better health outcomes than Britain—sees the NHS as a failure (p 51).

Richard Smith looks to the future (p 3), while Don Berwick, one of the world's leading experts on improvement in health care, looks back from the 75th NHS anniversary and sets eight principles for guidance (p 57). Some of these—make control over care as local as possible and use measurement for improvement not judgment—seem to conflict, as an editorial observes (p 5), with what the government is proposing. Another article discusses whether the private sector might flourish (p 66), while Diane Plampling observes that despite endless restructuring the NHS remains remarkably the same on the ground (p 69).

Gabriel Scally and Liam Donaldson try to spell out the meaning of clinical governance—the new big idea in the NHS (p 61)—while Andy Haines and Anna Donald start a new series on getting research findings into practice (p 72). Fiona Godlee discusses the many difficulties of doing so and describes the BMJ's proposed contribution—Clinical Evidence, a regularly updated compendium of best evidence that we would like to see in every clinician's pocket (p 6).

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