Intended for healthcare professionals


The NHS through American eyes

BMJ 2000; 321 doi: (Published 23 December 2000) Cite this as: BMJ 2000;321:1545

The NHS through American eyes

Editor - Everyone sees the world from the point of view on which they
stand. Seeing the National Health Service through American eyes,
Leatherman and Blackman believe that the NHS has fundamentally "got it
right" (23-30 December pp 1545-6). Yet, fundamentally, the NHS no longer
exists, for the 1990 Community Care Act changed the 1948 legislation that
underpinned it.

The National Health Service, Operational Research and Rehabilitation were
three health care legacies of the Second World War 1. The operational plan
that underpinned the NHS, transferred wards full of bed bound patients to
hospital care, from local government care. From that unlikely beginning,
the specialty of geriatrics began. 2 Take hospital responsibility for
providing a free long stay service away and the driving, rehabilitative
force, that underpinned the NHS ceases to exist.
During the Thatcher years a cruel trick was played on pensioners, as well
as on entrepreneurs. Using the rhetoric of markets, choice, and quality,
responsibility for long stay care for sick and disabled people was
transferred, by slight of hand, from the hospitals to the private and
voluntary sector. Thousands of hospital beds were closed; consultants in
geriatric medicine took on general medical duties; general physicians
became specialist physicians; waiting lists disappeared; everyone was
happy. Accept, that is pensioners paying for their own care.

In April 1993, government closed the open door. Now, we have the worst of
all deals. The NHS no longer exists; pensioners are being told that they
should insure for their long term care; nursing is being redefined to
exclude personal care (such as washing, dressing, feeding, toileting);
waiting lists are growing; acute hospital beds are full; and the whole
pack of cards is collapsing.

To make matters worse, the generation who fought the Second World War is
now in need of care. Yet New Labour is moving inexorably, away from
Beveridge, towards a Bismarck model of care for older people;3 soon, no
doubt, everyone will be means tested for long term care. What is needed
now, if a long-term vision for health and social care in the United
Kingdom is to be achieved, is a coherent, equitable, just and efficient
plan for all citizens acute, rehabilitative and long stay care.

Prof Peter H. Millard, MD, PhD, FRCP.

1. Timm, O.K. (1967). Rehabilitation to what? Journal of the American
Geriatrics Society, 15, 709-716.

2. Department of Health (1981). Report on a study of the respective
roles of the general acute and geriatric sectors in the care of the
elderly hospital patient. Department of Health. London. ISBN 0-902650-34-

Competing interests: No competing interests

18 January 2001
Peter H Millard