Tuesday, 13 March 2012

The NHS and Me

There is a poster in the window of the office of the attendants (they would be called concierges in more westerly postal districts) who look after me and the other residents of my City apartment block: "SAVE OUR NHS" it screams in a huge cerise font.

Now, I am a very child of the NHS: born in 1953, I was delivered by said service in east London (I could almost have been a Call the Midwife baby) and enveloped by it from both my and its earliest days.  It tended to my childhood ailments (often involving a GP's home visit), routinely tested my ears and eyes, inspected my feet and drilled my teeth.  It inoculated me against various diseases, the names of some of which - probably partly because of its existence - are rarely heard these days. It gave my mother concentrated orange juice for me to drink and - less welcome - cod-liver oil to swallow.  It even gave me my very own number which - though long since superseded by one with 10 digits - I remember to this day: MMQS 439.  And, notwithstanding the occasional recourse to private treatment, eg for slipped discs (believe me the physiotherapy's no less painful because you're paying for it), it is the NHS on which I continue to rely - quite heavily - to keep me healthy.  I am 58, not rich, and have had lifelong access to free basic healthcare.  My personal experience of a widish variety of hospital and specialist care has been variable but, on balance, positive.  I am, if you like, almost a walking testimonial for the comprehensive, free-at-the-point-of-use, cradle-to-grave care provided by the NHS.  I have as much reason to be sentimental about it as anyone.

And yet sentimental about it I am not. Someone has said that the NHS is the nearest thing we have to a national religion and, depressing as that is, it does perhaps help to explain the reaction to the Health Bill currently going through Parliament.  Some of this borders on the hysterical, and can be readily disregarded. Some is fairly crude political opportunism, and can be received accordingly.  Other criticism is more measured and/or more independent; and it makes sense to heed the reservations of those who actually work in the NHS, and on whom people like me depend for our care.  But there's no doubting the emotion involved.  I wonder if the proposed dismantling of the Church of England (which is our actual national religion) would provoke such passion?

I use the word "dismantling" because that is the word used repeatedly by its critics to summarise the present Government's intention with regard to the NHS; and it is that fear which is undoubtedly exciting much of the reaction.  I do not claim to have more than a layman's insight into it, but it seems to me that nothing like "dismantling" is actually on the cards.  Of the two main provisions, one (the extension of competition) is not on the face of it very controversial.  Competition within the NHS was introduced under Thatcherism and significantly extended under New Labour.  Some are and have been, perfectly rationally, opposed to it all along; but it is now, in one form or another, a reality of at least some aspects of almost of all public services. It's reasonable to question the extent of its influence, but a bit anachronistic to recoil in horror from the very idea.

The second of the two main provisions - the concentration of power and money in the hands of GPs - is a big change.  Who knows - it may well not work.  But does it constitute the dismantling of the entire structure?  I doubt it.  In fact the more you look at the Bill, the less radical it all seems; and I'm beginning to wonder if that's the real issue.

You see, if you treat the NHS less like a religion and more like any other taxpayer-funded service; if you can appreciate its strengths but admit its shortcomings; if you can be honest about your experience within it it while being realistic about what it can deliver in its present form, you may begin to think that nobody is being radical enough.  In the last 15 years, overall spending on the NHS has more than trebled - and even now, is continuing to rise slightly.  It's true that the rate of increase is now falling well behind increasing costs (which is why "net" cuts are necessary). But I cannot be the only NHS user on whom it has dawned that the recent massive increase in spending has still not given us the health service we want (ie one free of horror stories of the kind that pre-occupy the early evening news bulletins).  I cannot be the only NHS user who has observed that, satisfactory though my overall health care is, there are some things badly amiss with the NHS that do not seem to be susceptible to increased funding. Have you ever spent a night in an A&E unit? Have you ever been with a loved one during a serious health emergency and extended hospital stay? Have you tried to co-ordinate post-operative care when the hospital and the community health service don't appear able to talk to one another, and you are exhausted?  And, if so, are you still of the opinion that what is needed is simply increased funding?

I don't pretend to know what the answer is.  But I have a growing conviction that what is wrong is with the NHS is embedded in its very culture, which no amount of mere reform (or money) can hope to change.  This culture is one which bears little resemblance to that which existed when I was a child, and which instinct leads me to associate with the gradual disappearance of a certain sort of health professional driven primarily by vocation - this itself perhaps the result of wider social change.  I don't think the re-introduction of Hattie Jacques-style matrons - which some prescribe - would work.  Such people, and those whom they managed and mothered, simply do not exist any more.

This leads me to suspect that what we need is a completely new health service for a new society.  This means actually dismantling the NHS and replacing it with something else - perhaps something closer to the universally admired French system.  Now that would take political courage.


  1. I agree with all that you say.I was born in 1948, so am also an NHS 'customer' since childhood (yes, I hated the cod liver oil too and can still taste it).
    Overall, the machinery works quite well, as a machine, I think. But what seems to have gone completely is any sense that the NHS is primarily there to look after the patients. I know that sounds daft, but a frequent problem of bureaucracies is that in the end the bureaucrats feel they are there to service each other. A friend reminded me that in the Scouts, Baden Powell introduced a pyramid with The Boy at the top - everything else was to serve The Boy. Wouldn't it be marvellous if the NHS recast its mindset so that it existed first and foremost to serve The Patient?!

  2. Thanks for this, Laura. You make the key point (which I didn't) that the loss of patient focus is undoubtedly part of the problem. I wonder who knows how to solve it?

  3. I was born in 1937 which means I remember a time before the NHS . My grandparents had to make hard choices as to whether they could afford a doctor or not. It was either food or medicine but not both!
    Many children died from childhood illnesses because their parents failed to get a doctor out in time...
    I still remember the debates...often heated as to whether someone was ill enough to justify the expense,
    I know the NHS has many faults but by and large our local hospital is wonderful and the treatment available here excellent.
    I see the long term sick and I hear their concerns....here we are worried about the dismantling of NHS direct which is literally a God send for most!
    I would hate to see it all go!

  4. Thanks for this Jean. I'm sure you speak for many when you say that the NHS was heaven-sent and undoubtedly changed millions of lives for the better (including mine). I entirely sympathise with those who fear that it may be threatened.

    My point, I suppose, is to ask whether (good though your local service clearly is) the NHS as currently constituted can ever really be what we demand of a free, comprehensive health service for 62 million people from cradle to grave in 2012, given how conditions and expectations differ from those which obtained in 1948. The answer may be "yes", in which case we need to agree on what changes to make. But if it's "no", perhaps we need to be brave and think about rebuilding it from scratch. I don't pretend I know the answer!

  5. I think my views on the local situation may not be reflected else where.....this is small village. Our doctors live here, they come to church...are part of the community in fact. I can see that in towns and cities this would not happen.
    I also compare our situation with those countries who have no Health service.... There if they are well off and in good jobs they are perfectly happy with their health care...but the long term sick , old and poor may not be getting the same treatment.....Life is full of inequalities I know but if we can iron some of them out it can only be a good thing I think!
    LIke you I have no answer to how best to proceed....times have undoubtedly changed....but I am worried that the call for change may be political rather than driven by the need to improve things!