Founding principles
BMJ 2008; 336 doi: https://doi.org/10.1136/bmj.39582.501192.94 (Published 29 May 2008) Cite this as: BMJ 2008;336:1216All rapid responses
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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
STEPHEN MCCABE, PORTREE MEDICAL CENTRE, PORTREE, ISLE OF SKYE IV51 9PE
Competing interests:
None declared
Competing interests: No competing interests
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
Competing interests: No competing interests
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
Competing interests: No competing interests
Time to retire, and let younger generations take over ?
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
Competing interests: No competing interests