Our NHS: A celebration of 50 years

Ed Gordon Macpherson

BMJ Books, £25, pp 227

ISBN 0 7279 1279 8

Reviewed BMJ 25 July 1998

For me, this book turned a vague intuition into a focus for action in the future: rarely before can the gulf in the NHS between “top down” aspirations and local experience have been charted with such directness and honesty.

There is a deep contrast in this volume, with its 30 contributions, between the repeated powerful endorsement of the NHS as a national institution and the troubling personal experience of some contributors. The NHS appears as an organisation that has been kept in place by negatives—the blind, even pathetic, loyalty of patients and the desire of politicians to avoid trouble about funding. Much of the personal experience has been highly disquieting, and the BMA itself appears as a body that has been far more adept at manipulating these political forces than at leading towards professional models to meet this disquiet.

The book will outlast much else from the 50th anniversary by the sheer immediacy of many of its papers from key NHS contributors, helped by excellent editing so that the papers are short and graphic. Among the “local” contributors, Gilmour's tribute to his uncle's work at St Charles' Hospital for the London County Council and at Lewisham Hospital Group stands out. The “great camaraderie” of the London County Council hospitals was lost, but John Howard Simmons used the NHS as an opportunity in “forging the Lewisham Hospital Group into a committed and well organised service to its large catchment area.”

Rosemary Rue also gives a fascinating memoir, although for her the tale of public health under the NHS is mainly one of dissipation of an inheritance. “By the time I became a medical student as the war ended, there was widespread general knowledge of preventive health and a good deal of confidence in the country's ability to maintain and deliver health services, including those of public health.”

Melanie Phillips writes of the lost dream and finds she has been writing the same story about the NHS for almost a quarter of a century: from waiting lists out of control in Hemel Hempstead in 1974 to a chronic shortage of community care in London in 1994.Particularly poignant are the experiences of James Stoddart as a student fighting off “depersonalising jargon” as he clerked a long waiting, grateful patient in the “sun lounge” (or corridor); of Peter Plumley as a fed up surgeon fighting managers in Hastings; and of Abdul Jaleel seeing the behaviour of his colleagues when he was seeking a consultant appointment.

I was not surprised to find that most of the positive tributes to local initiatives came from general practice. David Williams, his father, and partner (father, son, and holy spirit) were able to transform their practice in Flintshire. Irvine and Godber report how a successful mix was achieved between national aspiration and local innovation with the family doctor charter—but only just in time. There are also positive accounts by Weatherall and Wade of the role of the NHS in medical research. Britain lost an early world lead in medical trials that had led the young Food and Drug Administration to speak of it with “awe and envy.”

For the future, Macara sees the NHS as likely to survive in some guise to the “last syllable of recorded time.” Ham and Robinson call for reappraisal, with more use of private finance and a more responsible and managed approach to evaluation. There is little good said about the 1989 reforms, but time may well change this verdict, and some testimony from a successful fundholder (and there were plenty of them) would have been useful. For me, this book has been a source of a New Year resolution to contribute constructively to the debate on the longer term future of the NHS. I don't want to see another generation go through the same mill. There must be a better way.