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The NHS 70th Anniversary and its changes; my 54 years experience evidence - Dr Bashir Qureshi

Whipps_Cross_Hospital_LondonIntroduction

The National Health Service (NHS) was officially launched by a Labour Health Secretary Rt. Hon. Aneurin Bevan at Park Hospital (now known as Trafford General Hospital) in Manchester, on the 5th July 1948. Under the umbrella of the NHS, all hospitals, doctors’ practices, nurses, pharmacists, opticians, dentists, carers, porters, paramedics and administrators were brought together to serve all patients; most of them were just recovering from being soldiers and supporters in World War II (1939 – 1945). The Conservative Governments have also been supporting the NHS as it fulfils the British nation’s needs. The NHS was expected to be free to everyone, for everything, at the point of delivery. It remained free for four years. As nothing but nothing is really free forever; a one shilling (5 pence) charge for prescriptions and a £1 for dental treatment charge were introduced on 1st June 1952. Since then, the NHS has been functioning as a combination of free, paid and private services. In this article, I point out some facts, I witnessed personally this experience evidence as a GP in London for 54 years; 22 June 1964 to 15 April 2018.

Formation

The concept of belonging to “one organisation” originated during the time of the Roman Empire; in that if all male citizens become soldiers in one army and women become their supporters, we can not only earn and keep our own national wealth but also influence or look after other countries’ wealth. Other European nations followed this custom. By this tradition even now, all British citizens belong to one state. It was noted that more of such earned money was being spent on Health for rich rather than poor citizens; therefore, the National Health Service was created by the Labour Government, led by Clement Richard Attlee, 1st Earl Attlee, who served as Prime Minister of the United Kingdom from 1945 to 1951 and Leader of the Labour Party from 1935 to 1955. This was a way to practice Socialism; in providing something for everyone. Nevertheless, affordable charges were introduced towards contribution to the cost. The Conservative Party always supported it whole heartedly, and the NHS has become and is a national asset.

Politics and Law

Politics, economics and law have as much to do with patient care as medicine. The Politics deals with realities and law keeps order; together they provide the quantity of services. The academics also play a major part in the NHS because they teach idealism and preach quality of provisions. Together, all of them are patients as well. They have first-hand experience of needs and resources to fund them. I observed that politicians and academics in Britain often disagree with each other because of the clash between realism to monitor quantity that is affordable and idealism to reach high quality whatever it costs, of the NHS services.

Administration

Consultants in hospitals, General Practitioners (GPs), Public Health Medical Officers and Managers were given power by politicians to run the NHS services. Their roles have been changing over the last 70 years, according to fewer finances available. GPs were in charge of their own practices, and finances were liberally provided by the Department of Health budget, in full as they claimed. Public Health Medical Officers controlled Disease Prevention Services; first under the Department of Health and later under Local Councils, then back to Health Department. The quantity and quality of services varied according to population needs and funds available in different regions of the UK. All healthcare professionals have their trade unions to protect their interests.

Hospital Services

An NHS Consultant or Specialist can only see those patients who have been seen and referred by General Practitioners (GPs), so as to qualify for NHS funding. Patients with serious diseases have been routinely referred by their GPs, seen by or admitted under a Consultant Specialist care and then discharged back to their GP with a discharge summary letter. In addition, emergencies have always been admitted from the Accident and Emergency Departments to the hospital. In the time of the British Empire & after World War II;

  1. Many Medical Schools were attached to some hospitals in London and other cities have been cut down by mergers.
  2. Many general hospitals have been reduced in numbers, size and staff. Some closed.
  3. The cottage hospitals, which were converted from ammunition making factories, were used for a few years and now they have been closed and the property has been sold.
  4. Geriatric wards or wings and Private patients units or blocks have been phased away gradually.
  5. Many new specialised hospitals and units have been built for diagnosis and treatment.

 

Medical_Officer_Child_HealthMental Health Services

A change of mind and circumstances is always a major problem for all Psychiatrists, managers and patients. Mental Health Services have been changing even more than other services in the NHS. In early days of the NHS, there were many mental hospitals and care homes together; seriously ill patients depended on care provided by the staff but less serious patients used to work either on the mental hospital premises and make saleable goods or used to go out to work for the day and return by night for medications and rest. As mental hospitals were expensive to run, these were gradually closed. Now, there are psychiatric wards for acute long stay psychiatric patients in local hospitals; the patient stay is kept as short as possible. Psychiatric patients are kept in Local Authorities rented houses in the community or with their families. Unfortunately some mentally disturbed persons now live as homeless in streets of London and other cities.

General Practice

It is a fact that a General Medical Practioner (GP) is expected to know everything about something related to medical problems and a Consultant Specialist in hospital is expected to know everything about something; focussing on their subject only. General Practice was pioneered by the British on 5th July 1948; it has always been the gateway of the Hospital Service where only serious diseases are treated. In affluent days, GPs were independent contractors for their own practices and practised single handed or in groups and the staff included their spouses as managers or treasurers. They employed full time or part time, salaried or locum doctors and other staff. GPs were called “Family Doctors” and they saw the whole family in their surgery or on home visits. In previous times, there were very brief notes in an envelope, no appointment system or computers. All patients used to come to their GP surgery daily; they were seen eventually as there was a social club atmosphere. Patients, who brought presents for staff, were seen first; it was considered a present and not a bribe. Many pharmaceutical companies used to spend a lot of money to run postgraduate courses with food and trips, even to Europe, for doctors and nurses, so that their products can be prescribed. This was accepted by the Health Department, centrally and locally, as if the GPs were private service providers. Now, all GPs are being merged in group practices and provided computers to replace hand written notes. Treats from pharmaceutical companies have disappeared along with them. Many GP’s are choosing to become salaried employees.

Public Health Service; Populations Care

Since 1948, Public Health Medical Officers have played an important role in disease prevention, control of infectious diseases, food and nutrition, obesity control, smoking cessation, drug addiction control and other preventive measures. Their function is related to populations and not to individuals. This service was first financed and run by Local Councils and then in 1980s, it was transferred to the NHS. They advise the British Government and other providers of preventive services. The size of this useful service has been changing according to need and demand by populations in various parts of the UK.

Queen_Elizabeth_IIClinical Public Health and Community Paediatrics

Clinical Public Health and Community Paediatrics in Britain existed for 50 years from 1948 to 1998. The staff consisted of many local teams; each team had one medical officer, a few health visitors and some school nurses along with administrative structure. Clinics for child development checks and immunisations were based in many places near schools in every borough. The functions consisted of child surveillance of every child, immunisation, detection and management of child abuse; physical and sexual, visits to local schools, special schools for disabled children and children care homes as well as nurseries. The clinical medical officer examined thoroughly every child at age of 6 weeks, 8 months, 2 ½ years and 4 years in clinic, then at ages of 5, 10 and 16 years in schools where teachers had access to the doctor and school nurses. As a child was born he or she was seen by a midwife for 15 days then by a health visitor until age 4 years. Then a school nurse would go to her designated schools daily. At age 16 years, the Clinical Medical Officer impartially used to sign 6 certificates for each adolescent; two were kept in their notes, two were given to employers as required, one was sent to the Home Office and one was sent to the Ministry of Defence. All adults were given certificates, indicating what job they can do or cannot do according to their physical capabilities or disabilities. Every child was looked after carefully. Since 1998 much has changed with more responsibility given to the GP, mid wife and teacher.

The Future

I foresee that in future, the Accident Department in one of five hospitals would remain open; Urgent Care Clinic, run by salaried GPs, at some hospitals would deal with emergencies only, brought in by paramedics or who walked in alone or with their relatives. GP surgeries would deal with non-urgent cases; staffed by one salaried GP and three physician assistants and a few nurses. No home visits by GPs. Every patient would have to ring 111 for non-urgent consultations and 999 for emergencies. An ambulance may or may not have one doctor accompanying two paramedics. Everyone working for the NHS would be salaried and managers would be able to estimate the budget for next year to claim from their local Health Department. Some services would be run by private companies who would also employ healthcare professionals. My guess is that the financial focus would be on life threatening conditions rather than chronic and minor illnesses.

Conclusion

The National Health Service in the United Kingdom is the envy of the world. The way it was founded, funded, made to function within available funds and constantly changing according to circumstances is a good example for other nations. The increased working and pensioner population in Britain today provides a challenge not just for the NHS but for society. The facts mentioned above are open to discussion among readers and hopefully worth thinking about positively for the future. Let us celebrate the 70th Anniversary; long may live the National Health Service in Britain. 

Dr_Bashir_Qureshi

Content provided by Dr Bashir Qureshi, MBBS, FRCGP, FRCPCH, AFOM-RCP, MICGP, FFHPMP, Hon FFSRH-RCOG, Hon FRSPH, Hon MAPHA-USA
Medical doctor, Author, Journalist, Writer, Guest Broadcaster, Politician, Expert Witness

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