Intended for healthcare professionals

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Analysis And Comment

Democratic control is essential

BMJ 2006; 333 doi: https://doi.org/10.1136/bmj.333.7561.251-a (Published 27 July 2006) Cite this as: BMJ 2006;333:251

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Without Winston Churchill the NHS would not exist.

Not Aneurin Bevan, who was Winston Churchill's "one man opposition"
during the wartime government.

In 1943, on March 21st Winston Churchill broadcast his Plan for Post-
war Britain,"echoing his own previous goals of 1908 and 1924, and drawing,
as he had done in 1908, on the ideas of William Beveridge: it was a report
by Beveridge that now served as a blueprint for the new scheme."

"In his broadcast Churchill spoke of the need to establish a National
Health Service on 'broad and solid foundations', to provide national
compulsory insurance 'from cradle to grave', and to ensure far wider
educational opportunities and 'fair competition' so extended that Britain
would draw its leaders from every type of school and wearing every kind of
tie'. Quoted from Martin Gilbert's "Churchill: A Life". Page 742.

In a subsequent broadcast on June 13th, 1945, Churchill stressed the
constructive aspects and aims of Conservatism, and elaborated on the
Coalition Government's Four-Year Plan prepared by Beveridge and made
public two years earlier, for social insurance, industrial injuries
insurance, and a National Health Service 'to be shaped by Parliament and
made to play a dynamic part in the life and security of every family and
home'. Martin Gilbert, "Churchill: A Life." page 847

Then it was Churchill whose photograph should have appeared, not
Aneurin Bevan's. Bevan was appointed Minister of Health in the subsequent
Labour Governemt and then introduced Winston Churchill's National Health
Service Bill.

In reviewing the management of the National Health Service today and
in the future more should be made of the experiience of the many retired
doctors who would willingly, for a little extra and certainly working
expenses, take part in showing a better way of organising the Service.
Management should listen and would then put their suggestions into
practice. That would be the proper way round.

Doctors would be encouraged more if they were paid per item of
service and would gain more satisfaction from the work that they did.
Salaries only make them lazy and work-shy.

Newly qualified doctors should not be forced to wait back in Hospital
House Jobs in their white coats but would be better employed, as in the
past, in gaining experience out in General Practice where, under
supervision and guidance, they could come to less harm and make fewer
mistakes.

In General Practice they would be seeing 90% of patients who are not
ill or not very ill and with their fresh learning be able to pick out the
10% who need further investigation and examination.

Instead of prescribing the latest antibiotic he would learn of the
old nostrums that tidied a patient over his first few days of illness
until the symptoms disappeared or a diagnosis could be made.

After five years outside, learning the ropes, they would be better
able to "communicate" and be an asset when called upon later to become
those white-coated In-house doctors. Perhaps then they would have the
ight "attitude".

The introduction of a plastic Medical Card would be an asset in
containing essential information about a patient that has been forgotten
and can later be used as a means of instantly paying the doctor's Fee.

This way it would be more cost effective. And the Service would
remain "free at the point of need" as the politicians insist upon!

Hospital ancillary services, such as X-ray and Scanning machines,
Pharmacies and Laboratories too could operate on a 24-hour basis to speed
up the processing of a diagnosis. It is done in America.

Nurses may well to choose to "walk out" if a Matron was re-
introduced. But there must be a "Control" and a need for discipline,
guidance and supervision of the untidy and slip-shod. The habit of unruly
and unkempt hair may be a modern fashion but that is not part of the
hospital service. Rudeness should not occur. Young school-leavers should
again be encouraged to take up the profession without having to tackle a
"degree course".

Hospital food could be vastly improved with the introduction of small
dishes of frozen meals, of a great variety, prepared outside the
hospital, that are microwaved on demand on the wards themselves. There
would be no need for the large and wasteful kitchens which now just spoil
the food.

Doctors themselves must be disciplined into arriving on the wards
less dishevelled and with clean clothes. One hears too much of the
"resistant Bacteria" that are brought in from outside.

And that is not all.

Competing interests:
NO COMPETING INTEREST

Competing interests: No competing interests

03 August 2006
GEORGE Y. CALDWELL
GENERAL PRACTITIONER
SINGAPORE 259858.
31 BALMORAL PARK, #18-33,