The NHS at 70
By the time I retire in September, if you include my years as a medical student and exclude my year abroad in Cambodia, I will have spent 35 years as part of the British National Health Service: exactly half the time it has been in existence.
What a privilege to have been able to serve in what I still believe to be one of the best health systems in the world. In a recent poll, readers of the BMJ voted “providing care based on need and free at the point of delivery” as the NHS’s greatest achievement in its 70 years (https://www.bmj.com/content/361/bmj.k2809). I fully agree. Having seen people in Cambodia die because they haven’t been able to access proper health care, and families go into irrecoverable debt to pay for worryingly poor hospital treatment, I am incredibly grateful for the care we receive from the nurses, doctors, cleaners, porters and all the other dedicated, hard-working staff I’ve had the privilege to work alongside.
“Illness is neither an indulgence for which people have to pay, nor an offence for which they should be penalised, but a misfortune the cost of which should be shared by the community” Aneurin Bevan.
There are, of course, countless other achievements of our national health service:
- General practice as the foundation of care
- Limiting commercial influence on patient care
- Pioneering evidence-based practice
- A comprehensive childhood vaccination programme
- Free contraception for all women
To name but a few.
As one commentator put it though, ‘perhaps the NHS’s greatest achievement is its sheer survival’. In spite of political interference, budget freezes, almost constant reorganisations, rising public demand, and media criticism, the people who make up the NHS continue to offer a great service.
Survival and change
In the years that I’ve known it, the NHS has changed. Gone (I trust) are those days of traipsing down a ward with my fellow medical students in the wake of an arrogant surgeon who would then proceed to humiliate both us as students and the patients under his (invariably it was a he) care. Gone are those not-so-halcyon junior doctor days of being on call for upwards of 72 hours and struggling to keep our eyes open long enough to write out a prescription or calculate the fluid requirements of one of our patients. Gone (to a large extent) are those days of treating patients according to a consultant’s whim rather than following protocols based on sound evidence.
But I wonder whether, with some of that, we have also lost something of the heart of the NHS? Of the camaraderie of those evenings on call, where we would linger with the nurses over a cup of hot chocolate on the children’s ward; of the small cottage hospitals where everyone called each other by their first name; of the sense of fulfilment when you had cared for a patient right through from their initial clerking in the emergency department to writing (by hand) their discharge letter as they walked out once more happy and healthy; of the art as well as the science of medicine?
Who knows?
Whatever the changes, and whatever may lie ahead for the NHS, as I retire from it, I feel incredibly proud and grateful to have been a part of what it is.