BRITAIN was a very different place in 1948 when the NHS was born. A quarter of homes had no electricity, and many did not have a telephone or an indoor toilet. Food rationing was still in place and healthcare was an unsatisfactory mix of private, municipal and charitable schemes.
Those who set up the NHS over 70 years ago could have had little idea how things would change, with advances in technologies and treatments in addition to the advent of new diseases. Also, in 1948, 5.5 per cent of the UK population were 65 or older compared to around 20 per cent today.
Over the years, several adjustments have been made to the way the NHS works. Some of these have been beneficial whereas others have undermined the founding principles of the NHS or the professionalism of those who work within it.
Despite a significant increase in the proportion of national income devoted to the NHS – rising from two to seven per cent – it is now creaking at the seams with daily stories of missed targets and distressed patients. To compound matters further, it is becoming a political football with all parties making increasingly ridiculous and unrealistic promises.
Having worked in the NHS for over 30 years, both as a GP and as a public health specialist, I should like to put forward five suggestions for our electioneering politicians to consider:
1. Restore trust. Junior doctors striking and senior doctors taking early retirement are symptoms of a general malaise affecting the medical profession. Trust and commitment between patients and doctors is the glue that has always held the NHS together. But nowadays it seems that a culture of suspicion pervades the health service with every action I take as a GP being scrutinised, controlled or questioned by a growing number of regulatory bodies.
For example, next week I will need to spend time away from seeing patients preparing for an annual appraisal in order to convince the local health authority that I am still trustworthy. Patients still seem to trust me – so what makes politicians or managers so sceptical about my continuing commitment to good patient care?
2. Improve management. Good management matters in any organisation and some have even argued that there aren’t enough managers within the NHS. But the issue is quality rather than quantity and I have come across some appalling practices within the NHS. Moreover, recycling poor managers between NHS organisations – or employing expensive external management consultants – simply compounds the problem.
3. Encourage responsibility. The NHS belongs to everyone, but we all need to use it wisely. Making an appointment to see a GP and then not turning up is, quite simply, selfish.
Also, individuals who don’t exercise, overeat, drink too much alcohol or smoke should consider the impact that such lifestyle choices will have on their own health and well-being in addition to the NHS.
4. Acquire common sense. The NHS could easily become a lot more efficient if we started using some common sense. For example, if a hospital consultant suggests that a patient of mine also needs to see one of her specialist colleagues, then why must the person make an appointment with me so that I can simply write another letter?
Also, why can’t individuals have three-month repeat prescriptions rather than having to make a new request every month? As most medicines I give are for long-term conditions such as high blood pressure, the current 28-day ruling seems illogical.
5. Find a great leader. Both as a junior doctor and as an apprentice GP, I came across doctors who I respected and, in some cases, sought to emulate.
But when I look at the doctors who occupy senior positions today, none would have inspired me when I was younger. Many seem to have ditched seeing any patients for a life sitting on committees or travelling the world.
There is a worryingly large number of doctors paid by the NHS who no longer practice but remain quite content to seek to regulate the activities of other doctors who still do.
Also, a peculiarity about NHS doctors in senior leadership positions is that they are often much more handsomely rewarded than those left continuing to deliver patient care.
The time has come to stop allowing the NHS to become a plaything for politicians or managers.
It was born out of an ideal that good healthcare should be available to all. Those responsible for leading the NHS must re-connect with their clinical colleagues, and keep the founding principles of the NHS in mind, if the National Health Service is survive to its 80th birthday.
Nick Summerton is a GP in East Yorkshire and author.