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Aneurin Bevan.
A HISTORY OF THE NATIONAL HEALTH SERVICE:
On the 5th July1948 the National Health Service was born. An apt use of personification. The NHS has helped bring ,probably, tens of millions of babies into this world during its 75 years of existence. The NHS took a while to gestate and come into existence, get born. The minister of health in the Clement Atlee’s post war Labour government, Aneurin Bevan, the son of a Welsh coalminer, who left school at the age of 14, brought it to fruition. He inaugurated the NHS at Park Hospital, Davyhulme, Manchester. The motivation to create the NHS was to provide a good healthcare for all. It had three founding principles which are still paramount today; firstly; the service was to help everybody, secondly; healthcare would be free and thirdly; the care required would be based on need rather ability to pay. The NHS was to be financed by the government from taxation. This how it is still financed today, with all the problems of rising costs and staffing issues and continually developing new drugs, procedures and modernising technologies that come along with that. It is an ever evolving organisation which needs managing with foresight, imagination and adaptability.
Before the NHS was actually inaugurated many people for decades had thought health care in the United Kingdom was insufficient and needed revolutionising. In 1909 a minority report by the Royal Commission on Poor Law headed by the social reformer Beatrice Webb argued for a replacement to the Poor Law which was still in existence since the time of Victorian Workhouses. However many in authority still believed that the poor and individual citizens should be responsible for themselves.This appears plausible but the vast chasm between the poor and the wealthy made this approach not only narrow minded and promoting self interest but was deadly for the less well off in society. The poor could not afford health care. In one way you could say that the nay sayers believed in a Darwinian approach, the survival of the fittest. From every moral ,social and even economic argument that was not right. Just from a societal economic point of view, If you have a healthy strong population at all levels of society surely the country will profit? We all know if we are healthy and strong we are happier and lead a better life. But, as always, what many had been used to, been brought up to, with attitudes and beliefs from the past ,it is always difficult to overcome. People find it difficult to accept change. Many powerful arguments for change were disregarded by the Liberal Government under Lloyd George. This did not deter those who wanted change and knew change was necessary. Dr Benjamin Moore from Liverpool had a pioneering vision and wrote a book called “The Dawn of the Health Age.”. He was the first to use the term National Health Service in his book. He helped create a state wide Medical Service Association in 1912. In 1929 the Local Government Act required Local Authorities to run medical services for everyone.On the 1st April 1930 the London County Council (LCC) began to run services in London for everyone.They took control of 140 hospitals and medical schools and abolished the Metropolitan Asylum Board. London had the largest healthcare service at that time.
Dr AJ Cronin wrote a novel called “The Citadel” published in 1937.It promoted new ideas about medical ethics inspiring ideas about a National Health Service. In 1938 “The Citadel, “was made into a film which many of the population watched in cinemas.
By1939 the outbreak of World War 2 came about.The people of Britain were to endure the Luftwaffe Blitzs. All the major industrial cities and ports around the coast of Britain were bombed.Casualties dead and injured were going to be inevitable. Out of wartime necessity a health service fit to react was needed. For the period of wartime a National Emergency Hospital Service was instigated and run by the Government.
This was the first iteration of our National Health Service. Out of wartime necessity it was proved that a health service run by the government for everybody and free at point of need could work.
In 1941 the Ministery of Health was in the process of agreeing a post war health policy. In 1942 The Beveridge Report recommended ,”comprehensive health and rehabilitation services.” This was supported by all parties.
When the war ended people had got used to the National Emergency Hospital Service and expected it to continue in some way. The cabinet endorsed the White paper put forward by the Conservative minister for health, Henry Willink in 1944 which set out the guidelines for a national health service. It was to be funded by general taxation This is still the way it is funded to this day in 2023. Initially everyone including visitors to Britain were to be included. Reciprocal agreements were made with other countries and it was to be free at the point of delivery. This is a fundamental principal that has continued since its founding. When labour got into power in 1945 under the Clement Atlee post war government Atlee got his minster of health Aneurin Bevin to take on the completion of the national health service.which he successfully did. There was and always has been a cross party consensus and agreement about the NHS.The British people consider the NHS a fundamental part of being British.
The National Health Service.
A HOSPITAL EXPERIENCE I WASN'T EXPECTING:
Just after my 71st birthday in June this year, I noticed I was having stomach problems. There was nothing major just some niggling symptoms that didn’t seem to go away. I felt fit and strong. I went out jogging most days in the local park. Marilyn was obviously more worried about my symptoms than I was. She persuaded me to phone up my doctor.I described to Dr Chang over the phone what was happening. I remember telling her I actually thought it was one of the pills I was taking that didn’t agree with me.I take statins and clopidogrel for a high cholesterol level which, by the way, is no longer high. My last test showed my cholesterol was at normal levels. Dr Chang sounded doubtful it was the pills and invited me to her surgery that afternoon for a physical check-up. She first felt my stomach. She took my blood pressure and then she took blood samples to send off to be tested. She gave me a ,”poo,” test kit to take home and return to the surgery the next day which I promptly did. The following week Dr Chang invited me back to her surgery. She told me particles of blood were found in my poo. She organised a CT scan, an MRI scan and a colonoscopy for me the following week at Queen Marys Hospital in Roehampton.
So, in brief, this is what has happened to me in the hands of the NHS.
I had a CT (computed tomography) scan followed, days later by a an MRI (magnetic resonance imaging) scan. Both of these took place at Queen Marys Hospital Roehampton. They showed up a number of things I was certainly not expecting. I was given a colonoscopy at Kingston Hospital. You really do not want me to describe that one. In essence, I was diagnosed with various polyps showing up inside my colon. However, there was also a large tumour inside my colon. An apparently benign cyst was also discovered on one of my kidneys. I had to go to Teddington Hospital, for an ultra sound scan on my kidneys. The nurse doing the ultrasound was very off hand and blaze. No concern over my cyst whatsoever. A good thing, I think.
Every Monday there is a conference in the Kngston, Surrey area between a number of top cancer specialists who deal with problems like mine. Two specialists from the Royal Marsden looked at my scans and results alongside the specialist from Kingston Hospital and a cancer specialist from Croydon Hospital. The two Royal Marsden specialists thought my tumour was a T2 tumour. The others thought it was a T1 tumour. What is the difference, you might ask? There are four layers to the colon. A T1 tumour has only entered the first layer. A T2 has entered the second layer. By the time it gets to a T4 tumour you are in big trouble. The tumour is beginning to spread around your body and a single operation can’t stop it. So what to do? The four specialists couldn’t decide. The two from The Royal Marsden thought I should have the section of my colon with the tumour inside removed and then that would be that. Things would heal up and in the future the stoma I would have could be reversed, and I would be mostly back to normal. The other two specialists thought I might possibly get away with it being removed internally without cutting into the colon. I went with the Royal Marsden surgeons decision which the surgeon at Kingston also changed his mind towards. He was, after all, going to do the operation on me. The specialists at The Royal Marsden are the country’s top cancer specialists. I was told I might be in hospital for seven days , possibly a little longer and I would certainly be up and walking the day after my operation. What could be so bad?
The Main Entrance to Kingston Hospital.
Friday 18thAugust Marilyn and I drive to Kingston Hospital at 7am, eventually find a parking space and walk to the building called Kingston Surgical Centre. I register at the reception desk. Oddly enough I have no worries. I don’t feel nervous. A nurse takes me to a room where I change into a hospital gown that reveals my bare backside. When the nurse comes back she gives me another gown to wear in reverse to cover my posterior. Marilyn gives me a kiss, wishes me good luck and tells me she will see me later that evening. Two lovely anaesthetists take over .My wristwatch is taken off me and put into a box which is labelled with my details. One of the anaesthetists is a Scotsman with a big red beard and I remember the other anaesthetist being jolly and jokey.
I remember nothing else until I wake up and I am hallucinating. I think I am standing on the ceiling. There are pleated curtains all round me. I can’t get my bearings. I don’t feel any pain until I try to sit up and I get some stabbing jabs in my stomach. I have tubes coming out of me everywhere. One down my nose into my stomach drains my stomach. A black rubber tube coming out of my left side drains blood into a bag attached to my side. I learn that its draining blood out of the operation site. A tube coming out of my bladder drains into a container hooked on to the side of my bed. I only discover that one when I want to go to the toilet and discover there is no reason for me to go to the toilet now. Everything is collected in containers which the nurses empty.I have two drips coming out of my right arm, a saline drip and an antibiotic and then of course there is the stoma bag . I have two buttons to press. One brings me a nurse. The other gives a me a dose of morphine if I need it.
Somebody, I think it was the surgeon in one the meetings, with Marilyn and myself, before the operation said that I would feel as though I had been ,
”run over by a bus.”
A medical technical term I think. In reality after the operation I felt as though I had been run over by a bus and it had then reversed back over me. All my energy and strength had disappeared. Marilyn, Abi and Emily appeared round my bed. It was an emotional moment.
The stages of recovery I went through included not being able to eat, my stoma not working and dehydration. I was sick a lot. I was given ,"St Marks Solution, "an extra strong type of Dioralyte. I had to drink a litre a day. It was like drinking sea water. I was sick again. Dehydration was my biggest problem after the operation. I was always on a saline drip, antibiotics and that bloody ,”seawater,” solution. Getting up and walking I could do although on a couple of occasions my blood pressure plummeted and I had to be helped to a chair. A dietician visited me and urged me to eat. I felt as though I had to do as I was told. So I ate and then vomited.
Eventually my body seemed to adjust. I started eating. I got stronger and I got home.
I am feeling good now, taking walks and driving the car again for short journeys. I can’t describe to you what Marilyn has done for me. She has been totally focussed. My diet and the physical changes to my body I still have to get used to,but I am getting there.
I was in hospital for three weeks. Where did the idea of seven days come from?
THE NURSES , DOCTORS AND STAFF:
The main story I want to tell you though is about the doctors, nurses and staff that looked after me and dedicated their expertise and their love to my recovery. Over three weeks I got to know some of them well.
One nurse came form Poland. She was the ward sister on a few occasions.She was short and stocky. I. got to know her quite well. She once was a Polish international weightlifter. She bemoaned ever being persuaded to take up the sport. Ever since she retired from weightlifting she had to keep to a certain diet and also do exercises to keep her muscles up to a certain level. If she didn’t it would affect her body and wouldn’t do her heart any good. She and her husband loved visiting the Highlands of Scotland and went deep sea fishing off the Scottish Coast.
Another muscular looking young man who told us it was his 21st birthday one day, had an amazing back story. We all told him how we wished we were all 21 again and assured him he had a whole life ahead of him. He went quiet and said to me.
” I have already had a whole lifetime behind me.”
I was surprised and asked what he meant. He told us that from the age of 16 he had gone into the Royal Marines and travelled the world. He had been discharged at the age of 19 and went into nursing. He was an expert free climber on rock faces and he was an expert scuba diver. He was so keen now to develop as a nurse and was applying for all sorts of courses.Us old fogies were taken aback to say the least. There were so many surprising stories like these behind many of the nurses we had.
A tall young Irishman , very brusque and dry sense of humour was our ward nurse a couple of times. He didn’t appear very often. He told me he lived in north London and it took an hour and half to drive to Kingston. I asked him why he did it. He said he loved nursing. He was registerd with a system called ,”bank,” which draws on nurses when and where they are needed. He said he only worked two days a week as a nurse. He is also a property developer. He and his wife have just bought two houses to renovate and sell on. He has building skills and his dad and brothers are all in the building trades. He said that was where he was going to make his money. I said ,
“Why do you continue to nurse?”
“I will always be a nurse. I love it too much. I can combine the two careers .”
I remember one night when a gentleman was moved on to our ward. A jolly West Indian nurse was in charge of us. He had all sorts of problems. He must have had fluid on his lungs and was finding breathing very difficult. This jolly nurse worked the whole night on him getting hold of oxygen and a pump to drain his lungs and the rest of us lay awake, all night, in silence listening. A doctor turned up at one stage and approved the nurses treatment and then left. She pulled her desk and laptop close to his bed so she could be with him all the time. She saved his life. That morning he was sitting up eating his breakfast.
Another nurse from Guyana was a ittle disgruntled one morning. She had been watching the Women's World Cup. She told me she had once been an international footballer with the Guyanese team and had played against some of the women in those national teams. She was past her playing days now of course.
The doctors came round every day to assess how we were doing They were so helpful and built up our confidence. Every other day the specialist ,who had performed my operation, came to see us. He usually had student doctors with him who stood around smiling and listening. Kingston is a University Hospital but we also got nurses and doctors from St Georges Hospital in Tooting.
I always felt that myself and everybody else were so well looked after and cared for ,and this was during the time doctors, nurses and specialists took turns on strike demanding better pay from the government. Even during strike days they did not miss a beat. Maybe it was because we were all serious cases . I did ask a nurse one day ,when the specialists were striking.
“Well what’s the difference today?I don’t notice anything different. “
She just said,
“There will be no operations today.”
There were three other men on my ward who I also got to know well. We were all retired from our respective careers, a maths teacher, a cancer research scientist who used to work for The Royal Marsden and had lead a team developing radio therapy( I kid you not, nobody escapes the BIG C) and an ex government scientist who worked on artificial intelligence at the National Physical Laboratory in Teddington and me an ex primary school teacher. We enjoyed each other’s company. We formed a team and the nurses called us ,”The Gang.” We all had had similar operations, not exactly the same though. Three of us are dealing with stomas. Anthony, on my right had escaped having a stoma. His colon was able to be re-joined during his operation.
Then I met ,”Magic.”He was there every day. He was an old Italian man who delivered our lunch and dinner to us. He knew I couldn’t eat much. He offered me delicacies such as cheese on crackers , which oddly enough I craved.
“ Red Leicester?” he whispered to me giving me a sly sideways grin.
“Oh yes. I’d love Red Leicester.”
On one occasion Magic gave me an apple. Apples are something else I began to crave oddly. However I couldn’t eat the skin.I asked Magic if he had a sharp knife I could use to peel it. We were only given blunt knives for our lunch and dinner that wouldn’t cut through blancmange if you tried. Magic looked at me.
“I got just the thing,” he said.
He came back with a knife, his knife, that was so sharp I could have shaved with it. Magic stood beside me while I peeled the apple in one continuous strip.
“Wow Mr Tony.”
He smiled.
After using that knife I have wondered since whether ,Magic, does a bit of freelance surgery on the side. I don’t know how he got the name, Magic. I heard the nurses calling him that.
GOVERNMENT AND POLITICS:
Last week the Labour Party had its national Conference at Liverpool. This particular conference was important and what was said , everybody in the country needed to listen to. We are coming up to a general election next year and the Conservatives are bankrupt of deas and indeed any moral standing after the debacle of recent years They are a mess and we really do need a proper change of government. Talking about the National Health Service and what Labour will do for the NHS ,Keir Starmer, the leader of the Labour Party is reported to having said in his party conference speech.
“Sir Keir noted that the shifts he planned for the NHS would be funded by cancelling ‘non-dom’ tax status, which allows someone who was born in another country to pay tax in the UK only on their UK income.
He said: “We will invest that money in boosting capacity, we will get the NHS working around the clock and we will pay staff properly to do it.
“More operations, more appointments and more diagnostic tests.
“You will be seen more quickly in an NHS clearing the backlog seven days a week.”
However, the leader of the opposition warned that reform of the health service was unavoidable, arguing that, without it, the NHS would “remain on life support”.
“We must be the government that finally transforms our NHS,” said Sir Keir.
“We can’t go on like this, with a sickness service.
“We need an NHS that prevents illness, keeps people healthy and out of hospital in the first place.”
Labour has also unveiled a new fund which has promised to give the NHS state-of-the-art equipment and new technology in order to help cut waiting times.
Sir Keir said: “We must use technology to overhaul every aspect of delivery, move care closer to communities [and] deploy the power of artificial intelligence to spot disease quickly.”
Suella Braverman , our present Home Secretary,should actually spend some time visiting hospitals and wards throughout the country. Our nurses and doctors come from all over Europe and the world. The NHS is a fantastic example of how immigration can improve and strengthen the UK and not weaken it and drain it of its resources as Suella would have you believe.
CONCLUSION:
The NHS has strong roots in the British people’s psyche. It has become a bedrock of our nation. At the 2012 Olympics in London there was a massive display featuring our NHS at the opening ceremony. This year, we have celebrated 75 years of the National Health Service. Our present government, a conservative one under Rishi Sunak, discusses and promotes new ways of how to develop and strengthen the NHS continually as a major government concern and policy.But words don't help. Only real action willhelp the NHS to develop. The NHS has problems with staffing, with pay demands, with overall funding and with its development and modernisation but these issues are always being addressed and plans are always in action to deal with them. It is affected by the economic problems caused by Russia’s war against Ukraine. It was strongly affected by the COVID pandemic and had to learn fast how to deal with that and people did die. It is not always successful, and disagreements about so many issues are permanently on going but it will always be a vital part of the life blood of Britain. The NHS is always in flux but its FANTASTIC!!!!.
ADDENDUM:
Information about the structure of and how the NHS is run from the government website.
https://www.gov.uk/government/publications/the-nhs-constitution-for-england/the-nhs-constitution-for-england
The NHS provides healthcare services to more than one million patients every 36 hours, and the vast majority of these services are free at the point of use for UK residents.
Many people think that the NHS is a single organisation with a central recruiting team, however this is not the case. The NHS is actually made up of multiple organisations, with each individual organisation having its own recruitment team and list of vacancies.
The structure of these NHS organisations varies slightly between the four UK nations, which is explained in more detail on the Health Careers website. In England, the organisations making up the NHS include:
• National bodies that oversee and regulate NHS services
• Integrated Care Systems (ICSs) that plan and commission care for local populations
• Healthcare provider organisations
• Primary care organisations – independent businesses offering NHS services, including GP practices, dental practices, opticians
• Acute (hospital) trusts – providers of hospital-based NHS services
• Mental health trusts – organisations which offer mental health and social care services
• Community trusts – providers of community-based services, such as district nursing, physiotherapy and speech and language therapy
• Ambulance trusts – organisations which offer NHS transportation services emergency and non-emergency care
WEBSITE: The NHS provides healthcare services to more than one million patients every 36 hours, and the vast majority of these services are free at the point of use for UK residents.
Many people think that the NHS is a single organisation with a central recruiting team, however this is not the case. The NHS is actually made up of multiple organisations, with each individual organisation having its own recruitment team and list of vacancies.
The structure of these NHS organisations varies slightly between the four UK nations, which is explained in more detail on the Health Careers website. In England, the organisations making up the NHS include:
National bodies that oversee and regulate NHS services
Integrated Care Systems (ICSs) that plan and commission care for local populations
Healthcare provider organisations
Primary care organisations – independent businesses offering NHS services, including GP practices, dental practices, opticians
Acute (hospital) trusts – providers of hospital-based NHS services
Mental health trusts – organisations which offer mental health and social care services
Community trusts – providers of community-based services, such as district nursing, physiotherapy and speech and language therapy
Ambulance trusts – organisations which offer NHS transportation services emergency and non-emergency care
