Jill Palmer – Prescriptions
THE National Health Services reaches its 60th birthday next year and, despite political interference, financial restraints and endless criticism, it is still going strong.
When it was created, it was the first of its kind in the world, the most sweeping reform ever introduced and it remains the unrivalled model of medical services that others envy.
It is hard for most of us to imagine life before the NHS. Many people just could not afford to go to the doctor. There was a huge cavern of unmet need. There were local authority and voluntary hospitals which provided free or subsidised care, but most were on the verge of bankruptcy. They survived only through fundraising, wealthy benefactors and the goodwill of consultants who gave their services free or for minimal charge while making their living from private patients’ fees.
All women and children had to pay to see the GP, as did many working men. It was only the low-paid working men who were provided with the services of a “panel†doctor in return for a compulsory four old pence a week in National Insurance contributions – equivalent to two pence in today’s money. The employer had to pay in three pence and the state two pence. But the deal did not include hospital care.
The NHS changed all this. Aneurin Bevan’s founding principle was to provide healthcare free at the point of delivery and based on need, not ability to pay. But even Bevan realised it would not be easy and, at the launch of the NHS on Monday July 5 1948, he declared: “We shall never have all we need. Expectations will always exceed capacity.â€
And he was right. Demand was far higher than anyone imagined. Spending in the first nine months proved to be two-thirds more than had been planned.
Yet the NHS revolutionised healthcare in this country and has continued to do so. Advances in drugs, treatments and surgery have been phenomenal over the past 60 years. New technologies have given access to treatments which were unimaginable in 1948 – heart by-pass surgery, organ transplants, childhood vaccination, gene therapy.
In the early days, the discovery of new and potent drugs, particularly antibiotics, saved millions of lives. Many of these new drugs were both scarce and very expensive. By 1950, just two years after the NHS began, there was already concern about escalating costs.
This resulted in the 1951 charges for dentures (half the cost) and spectacles (£1) being introduced. This decision so angered Bevan that he resigned from the Government. I can’t imagine many modern-day health ministers having the same brave principles. The following year, prescription charges of one shilling (five pence) were put into force and a flat-rate charge for all dental treatment was made, although check-ups were free.
In the 1950s and ’60s, came ultrasound for pregnant women, kidney dialysis and transplants, heart-lung machines used in surgery and hip replacements – all things we take for granted these days. The introduction of special care baby units in the 1960s saved the lives of many babies born too early or too small. There was no heart valve replacement until 1961.
The late ’60s and early ’70s saw incredible developments in cancer chemotherapy. The number of women dying in labour plummeted from 67 per 100,000 to 19 per 100,000 between 1952 and 1969, thanks to improved ante-natal care. CT scanners in the ’70s and even more highly sophisticated MRI scanners in the ’80s revolutionised brain surgery. Gene research in the ’90s resulted in amazing discoveries which will eventually lead to previously undreamt of improvements in medical treatments, allowing us to live healthier, longer lives. Britain became a world leader in new and effective forms of care. But with every breakthrough came increased demand. All saved lives. All cost money.
Countless millions of people have benefited from the NHS. These days millions more can be treated and cured. Premature birth, a heart attack and a cancer diagnosis are no longer a death sentence.
People in this country are living much longer. In 1948, the average life expectancy for a man was 66 and for a woman it was 71. Now it is 77 and 81, respectively. But old age brings ill-health. The risk of cancer, heart disease, circulatory problems, all increase with age. As we live longer, so our demands on the health service grow, which inevitably means that so does the cost.
So it is hardly surprising that, as the NHS approaches its 60th birthday, the cracks are showing. The NHS was born into a different era.
The present Labour Government came to power with plenty of good intentions but quickly discovered how hard it was to meet them. It has pumped billions extra into the NHS. However, it has also introduced targets, private finance, bureaucrats and red tape, which eat into those billions without necessarily helping patients. The introduction of foundation hospitals and independent treatment centres has only increased fears that Bevan’s ideal is being eroded.
The Labour Party created the health service and it should be giving it a special present on its 60th birthday. Nothing would be better than to make the NHS independent, in the same way as the Bank of England now is. Gordon Brown did it for the Bank of England, so why not the NHS? Let it be run on a long-term basis with lasting financial planning, not dependent on party politics and the short-term successes that are needed to win elections.
You can’t run a successful NHS with a deficit one financial year and a massive underspend the next. You can’t have a boom-and-bust health system. It doesn’t make economic sense. How can it be good management to jump from an overspend of £547 million in 2005/6 to an underspend of £510 million in 2006/07 and a projected £1.8 billion underspend this financial year?
That may be fine in the private sector, where the whole purpose is to make money. But the NHS exists to care for patients and to spend the money it is given for that purpose, not to have unused surplus cash.
