Saturday, 17 May 2014

Miss Polly had a dolly.


Miss Polly had a dolly who was sick, sick, sick.

So she phoned for the doctor to come quick, quick, quick.
The doctor came with his bag and his hat,
And knocked at the door with a rat-a-tat-tat. 

He looked at the dolly and shook his head,

And said "Miss Polly put her straight to bed.
He wrote a paper for a pill, pill, pill.
I'll be back in the morning with the bill, bill, bill.

I am sure that many of us know this nursery rhyme having heard it as a child and then sung it to our own children. The origins of the nursery rhyme are lost in the mist of time but the fact that a telephone is used would suggest late 19th or early 20th century.

You are probably wondering why have I started this piece with an old nursery rhyme but I would ask you to focus on the last two lines   "He wrote a paper for a pill, pill, pill. I'll be back in the morning with the bill, bill, bill."

In the UK the National Health Service is such an integral part of our life that we forget its origins are relatively recent and that before its creation the doctor would have presented a bill for payment. If you were rich like Miss Polly and owned a telephone you probably also had a family physician who was always available at the end of a phone and would have been one of the few men in town to own a car.

 
For those of a certain age Dr. Mopp from Camberwick Green
If you weren't as fortunate as Miss Polly then dolly was in trouble. Workers had some insurance cover but it didn't extend to their families. Local authorities provided some community hospitals but coverage was patchy.

If you were lucky there was a hospital for the poor funded by philanthropists such as Baron Ferdinand de Rothschild  (See my Day Four blog Old Hospital- New Hospital) - otherwise you relied on home remedies or medicines peddled by quack doctors whose effects were at best useless or at worse potentially dangerous.

A fact of life in pre-NHS days was that dolly had a 1 in 20 chance of not making it to her first birthday.

It was against this background that in 1942 Sir William Beveridge produced his report 'Social Insurance and Allied Services" and one of its key elements was a National Health Service.

Aneurin Bevan, Health Minister had the job of ensuring that legislation was passed by parliament and that a new National Health Service based on three core principles:

  • that it meet the needs of everyone
  • that it be free at the point of delivery
  • that it be based on clinical need, not ability to pay

was ready to open on 5th July 1948.

As parents of children with 22q we are indebted to the decision to create the NHS as over the years we have spent many hours and days in hospitals or out patients departments. In our view Sarah has always received great treatment from the medical staff at the various hospitals and clinics we have visited. If we had been presented with the bill it would have been for tens of thousands of pounds. We are very grateful for everything which has been done and remain firm supporters of the NHS.

Today the NHS is a huge organisation which for the fiscal year 2013/14 had planned expenditure of £110 billion. It is now the fourth biggest employer in the world after the Chinese People's Liberation Army , Indian Railways and Wal-Mart. The NHS has 1.7 million employees of which almost 850,000 are clinically qualified including 39,780 GPs and 370,327 nurses105,711 hospital and community health service medical and dental staff nurses.

The NHS serves a population of around 63mm people resident in the UK and deals with 1 million people every 36 hours. (Source: http://www.nhs.uk/NHSEngland/thenhs/about/Pages/overview.aspx).

There is not much we all agree on but I think I can say that the NHS is the one thing that everyone in the country is in favour of.

BUT

We have a growing ageing population, at the same time our scientists and doctors are discovering more treatments and drugs to keep us alive for longer.  We need to decide what services are to be provided and how they are to be paid for at a time when the country is borrowing around £100 billion a year to cover the difference between what it earns and what it spends.

To me it sounds like we need a grown up debate on what we want the NHS to be but unfortunately I don't think we are grown up enough to have such a debate.

This subject is often called the third rail of politics, if you touch it you will go up in smoke and I don't think any politician is really brave enough to debate this sensibly preferring instead to deal in slogans trying to persuade us that the NHS is only safe with them and not the other lot without really explaining how or why.

The medical staff continue to play to their strengths trying to treat more and more conditions which they will do until we tell them to stop. However we need to give them guidance and to prioritise what we need to treat on the NHS,  a new knee - definitely yes ? tattoo removal or repairing botched cosmetic surgery - probably no ? a new knee for a ninety year old ??

As users of the service we just want everything to be treated as quickly as possible and someone else to pay for it !  Just like kids who think their parents have an unlimited supply of cash.

Again what are our priorities and are we willing to pay more ? Are we willing to accept radical changes whilst still retaining the basic core principles set out when the NHS first started ?

Unfortunately there is no easy answer, but if we avoid these difficult decisions the services will drift, short term decisions will be made and we may end up in a place we don't want to be and wondering how we got there. Ideally the matter would be taken out of politics and all stakeholders could reach a consensus on a long term 10-20 year plan for what we want the service to look like but unfortunately I don't think that collectively we are brave enough or grown up enough to do that.

UPDATE - 21 November 2014

With the General Election less than 6 month away the chances of a grown up debate are non existent and until next May we will be bombarded by claim and counter claim from numerous politicians each maintaining that the NHS will only work if we re-elect them to look after it.

Already we have the major parties promising and extra £1 billion (£1,000,000,000) here and a £1 billion there. This sound a lot but with NHS in England spending £110 billion each year remember that a £1billion is approximately what the NHS currently spends in 80 hours (or 3.3 days) !

I would recommend this article from The Economist outlining some of the challenges that the service faces. http://www.economist.com/news/britain/21633900-politicians-squabble-over-englands-ailing-health-service-bureaucrats-have-offered-some



   



No comments:

Post a Comment