When I came into this world, the last occasion on which I found myself embarrassingly naked, I was accompanied by the first 'comprehensive' school in the UK, Indian independence heralding the closure of the British Empire, and the birth of the National Health Service. Reminding myself that this series of blogs is entitled ' My stories and experiences from past and present as well as my thoughts on the world today', I felt I might comment on the last of these, the largest political football of our time and a subject almost as important as football itself. This will not be a barrow load of laughs, about as exciting in fact as Hansard on interminable Brexit debates or page 943 of the Shanghai telephone directory.
Who am I? ( to borrow a phrase from a well known West End musical ); who am I to pontificate on such matters? I suppose my views are no more valid than the next person's but no less valuable either. The NHS is so important, we should not be leaving it to politicians but shouting about it from our rooftops.
Who am I? I am one of Britain's biggest and busiest hypochondriacs; I have always taken a vicarious interest in health matters. I grew up listening to Mrs Dale's Diary on the Home Service; I waited eagerly for the signature tune of Dr Finlay's Casebook; I was amazed by what seemed then the graphic detail on Emergency Ward 10. I suppose that, fifty years on, these have been replaced in my viewing schedule by Doc Martin, Casualty and Call the Midwife -- it's all the same really: ill health makes for good television drama.
Who am I? Please yawn as I am tediously autobiographical, being born in that generation before vaccination was common for many ailments; we just contracted diseases and got on with it. I survived, reasonably happily I think, measles, mumps, whooping cough and chicken pox and wonder if as a result we developed a degree of resilience, thereby obviating the need for special education and training in that human quality, which is so much in vogue today. Someone whipped out various parts of my anatomy which were regarded as surplus to requirements; my tonsils were stolen when I was very young; my appendix soon followed and I daresay, if there was a possibility of physical extraction, my libido was whisked away too!
Who am I? Slightly more unusually I was confined to bed for seven weeks in 1954 with quite a heavy dose of Scarlet Fever; when I was fourteen I had an intestinal stoppage, which led to a major operation ( I still bear the ten inch scar ) and the removal of some of my gizzards ( with apologies for not knowing the technical term ). A bout of pleurisy was followed by a long period of extremely robust health, punctuated only by operations on wobbly knees and, more recently, oscillating blood pressure and a fluttering heart.
But Who am I? I have attended the birth of our three children; no, that's not strictly true; one appeared on St Swithun's Day and it was so hot in the ward I thought I was about to pass out. I exited quickly to consume two packets of Opal Fruits ( why did someone have to change their name to Ghostbusters or some such? ) and stepped back in only to discover that I had missed the main event. These children and indeed two grandchildren have all sustained the normal slings and arrows of mixed fortune, necessitating use of the NHS. Finally my dear father was a Type 1 diabetic and an epileptic also so his contact with the medical profession throughout his life was extensive.
But still Who am I? In a professional capacity I have accompanied to hospital and shared the experience of: Tom who had a severe nut allergy, inadvertently consumed the wrong sort of chocolate, had his windpipe closing and his head swelling to a dangerous size; Jan, who had her stomach pumped after a near critical ingestion of strong liquor; Owen (and many others) with horrible sporting injuries; Judith who swallowed two bottles of asprin; Bob, a young teacher who suddenly developed acute meningitis; Charlie, also a teacher, whose kidneys ceased to function -- permanently; and Peter, one of too many, who died in hospital from the effects of cancer.
This somewhat tedious personal catalogue is not evidence of omniscience or any other quality on my part but shows a reasonably broad experience of the range of NHS services in various parts of the United Kingdom. There are doubtless weak links in this chain of provision but I have yet to find a serious one and I do not believe there are many. The local doctors' practices have without exception been all that one could want -- efficient and courteous at the level of reception; perceptive, expert, empathetic and unfailingly helpful in the doctor's room. My experience of this has found its apogee in the truly excellent Observatory Medical Practice in Jericho (that's Oxford, not just down the road from Jerusalem).
In hospitals I have found and continue to find in the extremely busy and hard pressed Oxford establishments all members of staff -- medical, administrative and support -- courteous, considerate and helpful. Although numbers are vast, outpatients are dealt with efficiently but never officiously, while the care offered to inpatients, often under great pressure, is nothing less than superb. In recent years I have been a patient in both NHS and private hospitals and the former was superior in every way -- care, consistency and particularly communication. I hope that those who make laws about who can enter the country are not so preoccupied with the purity of ethnic background that they reject so many excellent professionals who could fill worrying gaps. However, we should also take heart from the practitioners we know personally rather than professionally. I heard this week of a former student , who I always thought would be an exceptional doctor being appointed Registrar at a young age. When I walk on Wolvercote Common at 7am, I sometimes encounter a local Health Visitor, the very best of people who is clearly outstanding at her job. Everywhere there are brilliant people who should give us great hope. With apologies, I feel a little Shakespeare coming on. ' I have seen a medicine that's able to breathe life into a stone '. If we substitute ' medical people ' for ' medicine ', perhaps we have a picture of those working in the NHS and when one remembers that this quote comes from ' All's well that ends well ', there is hope indeed.
And yet we are told that targets for waiting times for operations and at A & E are not met; cancer survival rates are better elsewhere and in various places more per head is spent on health. But rarely is like being compared with like and targets are a menace as they can lead to corners being cut and to a culture of winners and losers. They raise expectations to absurd levels and encourage a climate of entitlement. I think we should be sceptical about them at least. In Act 5 of Macbeth, the Doctor on seeing Lady Macbeth's loss of mental faculties through her sleepwalking says ' Therein the patient must minister to himself ', that is ' I can't cope with this; she has to sort it out for herself '. The beliefs and practice of the NHS, in my observation, are the exact opposite of this.
So I maintain complete faith in, and admiration for, the National Health Service. I say this for two obvious reasons; first, it is genuinely national; it is there for all of us whoever and wherever we may be as well as our friends and relatives visiting from elsewhere. This was revolutionary in 1948 and it is only a little less remarkable today. Secondly it is a true service, the government on our behalf provides it free at the point of delivery to the citizens for whom it is at once a right and a privilege. This fundamental ethos fosters that deep commitment in those working in the NHS to ensure that society as a whole and every individual member enjoys the best possible health and receive the best possible treatment when things go wrong. They are philosophically engaged in an endeavour without equal and old man Hippocrates of Kos would have been very proud of them.
And yet ..... and yet tensions remain between those who want more money, a government which says there isn't any, those who look to reform of the system and those with sundry other axes to grind. From an admitted position of almost total ignorance I will say what I think should happen.
1 We, the people, through whatever appropriate forums and representatives are available to us, should decide what the NHS should be doing and looking like almost a hundred years after its foundation and in a totally different social context, where mental pressures are much greater and where people are living longer with attendant physical or mental ailments. I firmly believe, in keeping with the original philosophy, we should be, through the NHS, looking after all the health needs of all citizens from womb to tomb. This naturally means inter alia that all care services become the responsibility of the NHS, not a half-baked ' alongside ' relationship.
2 We should take steps to be sure that the NHS is run as well, as efficiently and as cost effectively as it possibly can. It is perhaps the greatest failing of government in this area in the past ten years that this has not happened. A few years ago a sparkling new IT system was scrapped at a remarkable cost of £10 billion. The Head of a Hospital Trust loses her job worth £180,000 ( an absurd sum for an administrator anyway ) quite rightly as many had died in her care but the authorities then invent a brand new job for her at the same salary -- what an insult to doctors and nurses. Certain NHS areas in the north of England have the best achievement rates in the country, putting this down to greater flexibility, improved communication etc but areas further south, in a display of perhaps a little too much pride and certainly too much prejudice, are not prepared to experiment with new procedures, while government is reluctant to cajole them into doing so. Extra funding (see below) may be the key but this is conditional on the organisation of the service at a national level being as good as it can possibly be.
3 Once it is agreed what the NHS is to provide and aspects of the service are reformed to make them as effective and efficient as they can be, we simply should be prepared to provide what is needed for the 'new' service to run properly and that will be a good deal more than it costs at present. At that moment there will need to be increases in National Insurance or in Income Tax and I believe we should be both open and relaxed about this provided the additional costs are fairly distributed. . I suspect that many of us are prepared 2p or 3p more in the £ if we knew it was going to be invested in an even better National Health Service. Clearly the major burden should fall on those most able to pay.
I have stated a simplistic, obvious, possibly tedious (apologies) case. The NHS is special; it is precious; it should not be a political football; it needs clear thinking, rational planning and more cash which will need to come from us not from them. Meanwhile thank you to so many wonderful people for providing such an excellent service.
This national service is free,
That's health for us all without fee;
Since India went down,
This jewel in the crown
Needs due respect plus TLC.
30th January 2018
