The NHS at 70
Britain’s National Health Service celebrated its 70th anniversary last week, having come into effect on July 5th 1948. Despite a relatively limited personal use of the Service with only one hospital stay for overnight observation following a head injury sustained during a mountaineering accident in the Lake District in 1976, and continued checks in the ophthalmology department to monitor for trauma-induced glaucoma after being hit by a squash ball in the eye in 2007, it’s good to know that a comprehensive health service, free at the point of delivery for everyone regardless of ability to pay, exists in the UK. Sadly, free universal and comprehensive healthcare in the UK has been under attack for much of the last 40 years, even when Blair’s New Labour was increasing health spending by an average 5.4% per year, selling the public the idea of new hospitals (and other major projects) but actually committing the coffers in the public purse to fatally flawed PPI ventures from which hospitals in particular continue to suffer.
It’s widely remarked that the NHS has a special place in the hearts of British citizens although it’s always been highly politicised. Conceived by health minister Aneurin Bevan and introduced by Clement Attlee’s post-war Labour government, there was considerable opposition to the scheme amongst those with vested interests. Many doctors did not want to become employees of the government; hospital consultants wanted to continue to charge private patients for treatment and 64% of GPs opposed the NHS, preferring to treat patients privately, leading to the BMA to organise a campaign to ‘boot out Bevan’. Even nurses were against the plan, as it threatened their income from private family visits. Bevan finally won round doctors with the promise of new hospitals and badly needed equipment but significantly also agreed to allow doctors to continue to treat private patients in addition to their NHS work.
Universal Access: The NHS was for all
Comprehensive: The NHS would treat all medical conditions. Doctors, dentists, opticians and hospital treatments would all form part of the service
Free at the point of need: Patients would not pay for treatment. The new NHS was to be paid for out of National Insurance contributions and would provide free medical services for all
I’ve been involved the service since 1981, one of the behind-the-scenes staff in a laboratory. Initially employed by the National Blood Transfusion Service immediately after graduation, within five years I’d expressed a few hundred litres of plasma from whole blood, pooled platelets, washed blood, made clotting factors VIII and IX, provided reagents derived from blood donations to hospitals in the South East, screened ante natal blood for antibodies to prevent haemolytic disease of the newborn and selected and crossmatched units of blood for patients requiring transfusion. I was working there in 1983 the virus responsible for AIDS was independently discovered by Gallo in the US and Barré-Sinoussi/Montagnier in France, naming the novel retrovirus HTLV-III and LAV respectively, before it became known as HIV in 1986 and, to reflect the importance of that discovery, changed the name of the band I was in at that time to HTLV-III.
In 1984 I moved to the section that covered bone marrow transplantation but after a successful two years in that post, I was told I was to be moved to a different department. Fortunately my predecessor, who had left to join the kidney transplant team at Charing Cross Hospital, was moving on to Scotland; I applied for and was appointed to fill that vacancy, delivering a leaving party speech that criticised the management of the Transfusion Centre for virtually forcing me out. It’s satisfying but disappointing that things got much worse there after I left, all due to poor strategic decisions in search of ‘efficiencies’.
View from the Tissue Typing Laboratory, 9N Charing Cross Hospital (c.1987)
The lab at Charing Cross was small and friendly and though much of the work was for renal transplants, we were actually part of the Rheumatology Department. It’s good to have a different perspective, and meeting professionals from other disciplines helped me see healthcare from a holistic point of view. With rumours of a pathology reorganisation circulating in 1988, a post at Guy’s Hospital offering research potential and an annual international conference proved too good to resist. The Guy’s lab had something of a mixed reputation when I joined but within a couple of years we started to make some astute personnel changes and began to build up one of the most successful renal transplant teams in the UK, no longer treated as just a laboratory but sharing expertise with the medical and nursing teams.
Guy's Hospital c.1990
The Conservatives introduced the National Health Service and Community Care Act 1990 which created an ‘internal market’ for the supply of healthcare so that the state would no longer be the main provider, but act more as an enabler, forcing local authorities to assess people for social care and support to determine a patient’s requirements and to purchase the care from providers – the new NHS Trusts. Guy’s and Lewisham joined forces and became the Tories’ flagship Trust but hospital reorganisation in London, to make the service yet more efficient, meant that the Guy’s – Lewisham partnership was dissolved and Guy’s & St Thomas’ NHS Foundation Trust, complete with a level of autonomy from the Department of Health, was created in 1993. A few years before, Guy’s had been singled out for major improvement, the construction of the £140m Philip Harris House, a state-of-the-art seven storey wing designed to be conducive to effective healthcare. However, the inexplicable transfer of acute services to St Thomas’ Hospital where the finances and physical fabric were in a parlous state before the formation of the Foundation Trust, a politically motivated move disguised by a major reorganisation of all London hospitals, led to carpet magnate and Conservative Party donor Philip Harris withholding his £6 million from the project; the building sat empty for some time before being reassigned for outpatient services and some research facilities under the name of Thomas Guy House. The loss of services from Guy’s was fought under the banner ‘Save Guy’s Hospital’ where one of the organisers of the campaign was the lead kidney transplant surgeon whose office was based in my lab.
The creation of NHS Trusts immediately increased the running costs of a hospital because of the number of managers required to oversee the internal market and to control budgets. Cutting waste and making efficiencies has long been the mantra of officials but they failed to see the hypocrisy of paying management consultancies huge sums of money to produce reports to validate decisions made by hospital boards to circumvent discussion. This continued after Blair replaced John Major as PM in an attempt to show the public that New Labour was both a prudent manager of the public purse and that it was business-friendly. The machinations of GSTT managers or ministers in the Department of Health didn’t impact on me directly until 2008 when, encouraged by a government which delighted in ‘a third way’ but based on poor data collected pre-2006 for the Carter Report, it was proposed that pathology at Guy’s and St Thomas’ (also to include Bedford Hospital) should be part-privatised in a joint venture between the hospitals and outsourcing darlings Serco. Despite opposition from staff throughout the hospital and sympathy from the chair of the board of governors, the Joint Venture commenced operating under the title of GSTS Pathology on January 1st 2009. To ensure I couldn’t be singled out for my outspoken opposition to this development, I became a union representative and campaigned vigorously to stop all forms of NHS privatisation and the unfair treatment of staff.
GSTT was at the forefront of removing staff from its books through a series of privatisations; Pathology, the Post Room, Pharmacy, seemingly simultaneously oblivious to the wishes of staff and mounting evidence to show that in fact, privatisation was a contributory factor in declining standards of delivery of care. When the coalition government was formed in 2010 they quickly revealed a major shake-up in the provision of healthcare, Andrew Lansley’s Health and Social Care Bill (enacted in 2012), despite a Conservative manifesto pledge that there would be no NHS reorganisation. Now largely scrapped though still adversely affecting the NHS, other changes to public sector pensions and terms and conditions of work introduced by the coalition shortly after they came to power were part of a strategy to entice private sector providers to take over services; unfortunately the strategy worked, seriously affecting provision of comprehensive, universal healthcare. According to a report by the NHS Support Federation, £7.1bn worth of NHS clinical contracts were awarded through an NHS tendering process in the year up to April 2017. The changes were sold to the public as being necessary in an age of austerity but the government was defending its friends and the failed ideology that caused the collapse of the global financial system in 2008; George Osborne’s imposition of austerity measures to eradicate the budget deficit was really another strategy to break up any power remaining in the hands of the state and politicians and economists alike have criticised the approach, which is responsible for a continuing weak, low-growth economy.
On the occasion of the NHS’s 63rd birthday, I predicted that unless there was a change in administration, it would barely make it to 68. Fortunately I was wrong, though how it managed to survive the last three winter crises and a lengthy doctor’s strike is a miracle. It appears that the cuts to NHS funding have now been stopped but there’s still insufficient movement on the investment required for integrating health and social services. However much money we put into health is never going to be enough but it’s pleasing to see that the British public would accept a tax rise for the NHS. Bevan’s guiding principles for the service illustrate a willingness to eradicate inequality and what he founded may stand as the highest achievement of social democracy. To ensure his legacy continues to have a future we need to recognise the value of everyone who plays a role in healthcare provision, from the cleaners and the porters and post room staff and catering staff upwards. Jeremy Corbyn’s recent call to end the NHS internal market is also a key move, as competition between providers is likely to lead to unrealistic tenders, an uneven provision of care or a diminution of quality; the Lansley Act had the detrimental effect of splitting effective care pathways and raising costs through inefficiency.
I left Viapath (the re-branded GSTS Pathology) in 2015 to restart as an NHS employee in a different NHS Trust. Despite a national celebration of the service on its 70th birthday, I didn’t join in because the cheerleaders for the day, the higher managers who sanction privatisation of services and impose punitive sickness policies, were handing out free muffins to all staff. The passion that many millions share for the NHS, despite its shortcomings, is the reason it’s still going and anyone who cares to can check that it ranks very highly on efficiency and social equity; the US with its private insurance-based system favoured by some of the more right-wing members of the Conservative party, spends far more on health per person with poorer and dreadfully inequitable outcomes.
So what’s the NHS got to do with progressive rock? Apart from the excellent band National Health (see ProgBlog’s February 2014 post National Health), it’s about the prevailing social conditions in the late 60s and the notion of equity of access; the founding of the NHS is one of the defining features of advanced social democracy, along with the provision of decent social housing, and opened the door for further democratising movements like access to higher education for students from all backgrounds. The prime movers in progressive rock appealed to the burgeoning student groups but also envisioned a better world and even attempted to challenge accepted norms through bridging the two worlds of high- and popular culture; I don’t believe that progressive rock would have developed in Britain in the same way if we’d not already made moves to make society more equal.
So the next challenge is to see how the NHS fares post-Brexit, but I agree with the words attributed to Bevan: the NHS will last as long as there’s folk with faith left to fight for it.