|The NHS - From Creation and Conception to Failure and Internment|
In 1946 the newly elected Labour government introduced, with a great fanfare, the National Health Service. A service which was to provide compete health care from cradle to grave and free at the point of delivery for UK citizens. No longer would the great British public have to worry where the next penny was coming from to pay the doctor or hospital or for the expensive drugs needed to cure their ailments. But, what that Labour government did not take into account was the fact that whenever something is 'free', it is a natural human tendency for people to take as much as they can get their hands on regardless of the cost to the provider. Nevertheless, and for 50 years we were reminded time and time again that the NHS was safe in Labour hands. But let me ramble a little before I come back to the subject.
As the proud holder of a medical degree and after four years hospital experience in medicine, surgery, orthopaedics and accident and emergency, it was with some trepidation that I dipped my toe into what I thought was the more family friendly environment of general practice. In those days 'assistant with a view' for three years was the norm despite the fact that it was three years when the senior partners screwed every ounce of working hours out of the junior assistant for a pittance of a salary.
I joined a 5 man practice in south Wales where as the junior, and as well as the normal working day, I covered every Monday and Wednesday night and every other weekend on call. And nights on call, meant covering 10,000 very demanding Welsh patients, hardly seeing the family and rarely getting more than an hour or two of uninterrupted sleep each night - and I was still expected to be in surgery the following morning. And all this for the princely sum of £250 a month while my seniors struggled to exist on a miserly £800. No European Directive maximum working hours in those days; rarely did my actual working week - and I mean physically working - drop below an average of 120 hours a week.
Yes, they were hectic times but there was always light at the end of the tunnel and that tunnel proved to be a literal goldmine of experience. I covered virtually every conceivable emergency from heart attacks to childbirth, meningitis to measles, broken bones to suicides and, as stand in police surgeon, road accidents and drink drivers.
As time went on I had the opportunity move to a less demanding practice in the English shires. There my partners were much more empathetic and presented me with a one in four duty rota and a much more generous pay cheque. The patients too seemed come out of a different mold than their Welsh counterparts and there were many nights when I would wake in the morning having experienced a full night’s sleep! ! These were good days when I was able to concentrate my time on providing good general practice and begin to specialise in aspects of medicine that appealed to me such as pre hospital emergency care and in flight repatriation medicine.
But, as time went on, night time demands from an ever expectant public became greater and greater. And, in a small practice, the fact that you head been up most of the night didn't relieve you of having to cope with the overbooked surgery the following morning. We come back to the argument - when something is 'free' the public will take as much as they can get their hands on - and that includes out-of-hours demands for emergency dandruff, emergency in growing toe nails, emergency toothache (dentists don't do out-of-hours), emergency insomnia, emergency nosebleeds as well as the occasional heart attack, asthma attack and stroke.
The time had come for a major overhaul of the out-of-hours system in general practice and I was fortunate in being one of the instigators and architects of a near perfect system in the early 1990s. A rota of some 50 GPs based at the local hospital from 6pm until 8am, where two doctors and an experienced nurse would provide complete out-of-hours general practice care for a population of some 100,000 people. Admittedly the great majority of callers would be expected to attend the hospital clinic to see one of the doctors or the nurse but the other doctor would be out on the road dealing with those genuine emergencies who could not travel.
The whole concept meant an excellent out-of-hours general practice service provided by familiar local doctors who would be working a leisurely 1 in 25 on call rota followed by a day off to catch up on sleep. The system worked well and with few exceptions was popular with patients and doctors. No four hour waits in overburdened A&E departments, no ill qualified 111 telephone operators and no 'NHS at crisis point'. So what has gone wrong?
Let's go back to the Labour party fanfare - 'The NHS is safe in our hands'. There is no question whatsoever that the current crisis in the Health Service goes back to the new GP contract introduced in 2002 - by whom? None other than the 'NHS safe in our hands' Labour party! Under the new contact agreed by the Labour government, GPs were given the opportunity to drop out of out-of-hours care provision completely. The penalty? A measly £6000 a year which was soon made up through other means.
And what alternative did the government have in mind to replace the out of hours care - as the current crisis in the NHS proves, absolutely nothing. We are left with whole counties depending on a nurse for out of hours care; it sometimes takes a doctor 4-6 hours to respond to emergency calls; locum doctors earn over £ 1000 for 12 hour shifts; foreign locum doctors struggle with language ; 4 hour waits to be seen in overburdened casualty departments - the list of catastrophe goes on and on.
Sorry, the NHS was never safe on Labour hands. A system where service provision is in the demanding hands of the customer will never work be it a health service or any other public service. The Labour Party introduced the NHS and now they must take the blame for having destroyed it.