Intended for healthcare professionals

Editor's Choice

Brexit: doctors’ duty is to inform patients

BMJ 2019; 366 doi: (Published 05 September 2019) Cite this as: BMJ 2019;366:l5382

Re: Brexit: doctors’ duty is to inform patients

Thank you for your response, and basically your agreement. I have worked in the UK, North America and Africa and examined, and inspected and advised on health services and medical teaching worldwide for Royal Colleges, British Council and WHO inter alia. I have also been a patient in Italy and Spain.

I am not proposing that we move to Albania!

Like many others I was bemused when the then Mayor of London chose to showcase the NHS as an outstanding feature of this country during a major international event, because I know of no other country, apart from one (see below) which has copied it. Yet for decades we have repeatedly been told that the NHS is "the envy of the world". I also know of no other country where staff work harder or morale is lower.

This is a result of decades of underinvestment by successive governments of all persuasions. We have not trained doctors and nurses, preferring to get other countries to train them at their expense. Trained staff have then been enticed to the UK by paying them higher salaries. Even then, our Home Office denies them entry for long periods even when they have a confirmed job to come to. I know my way around the NHS and thus avoid many of the problems faced by what the previous Prime Minister called the "Just About Managing". These people (JAMs) made up many of my, and probably your patients.

I am old enough to remember the inauguration of the NHS, and life as a child patient during WW2, when parents had to consider whether they could afford to call a GP. We have come a long way since Churchill announced in 1943 that "after war, we will have a National Health Service" In those early post-war days, it really was the envy of the world. It was the model chosen by rebuilding Japan, because their health status was so poor and survival (even before the war) was well below that in the West. They have never changed it, and now Japan has the longest-living population, the lowest infant mortality, longest survival for most cancers and so on. it was because we allowed the NHS to be politicised that we do not have the same.

I return to my original view that politicians, like us doctors, do not experience the reality of our beloved NHS for the people for whom they provide it. They visit hospitals as honoured visitors, or "special" patients. No amount of targets, guidelines sanctions, and additional civil servants will alter the negative flow of trained staff or produce more professionals. It is easy to blame doctors and others for failure to meet targets. But when will any Government grasp the nettle?

Competing interests: No competing interests

13 September 2019
John A Dodge
(1) Emeritus Professor of Child Health., (2) Hon Professor, Swansea University