Keith Pearson on valuing the NHS

30 June, 2008 | By Keith Pearson

The Russian author Tatyana Tolstaya once said of her homeland: 'For us, the best time is always yesterday.' As we prepare for the 60th anniversary of the NHS, I look around and worry that too many people believe this is as true of the NHS today as Russia in 1990.

It is time for us, as non-executives, to stand up and say no, this is not true now and has never been true.

The best in the NHS is transitory, of the moment, a snapshot in time. When, in 1948, a cataract operation involved a week of immobility with the patient's head resting on sandbags, it was the best. It was magnificent, the cutting edge of medicine, for the first time delivered free at the point of care, according to need, not wallet.

Now, 20 minutes for the operation and home on the same day is the best, and it is still free at the point of care, according to need, not ability to pay.

Gold standard

The NHS of the past was great, a brave and brilliant institution of its time. Each generation of staff and patients thinks theirs was the golden era. And it is true. Throughout its history, the NHS has been the gold standard, the service to which the world aspired. The reason it has remained the gold standard is that it has changed and moved with the times.

However, that is not to say there were never any problems before today. There have always been issues and concerns and lobby groups and special interests. That is the nature of a universal service.

In other words, the staff who worked in the NHS in the past, some of whom still grace us with their skills and passion today, created an institution that was the envy of the world at the time.

We need to pay due regard to these people. We need to celebrate their accomplishments and their commitment. The NHS's 60th anniversary is the time to do it. But, we also need to recognise that they prepared the NHS for its tomorrows. They made changes and embraced progress so that the next generation could also say, here and now, our NHS is the best it can be.

Not perfect

We must laud the past, but not live in it. The past was not perfect. In its first year, the NHS cost£248m to run, about£140m more than expected, which puts our deficits of recent years into perspective.

In 1948, the NHS had 125,000 nurses and 5,000 consultants. Today, there are 400,000 nurses and 90,000 hospital doctors.

In 2008, the NHS budget is about 10 times as much, in real terms, as the original NHS budget.

Men and women are now living an average of 10 years longer than in 1948. Today is better than yesterday.

Time for reflection

We need to use this 60th birthday to look back on the life of the NHS and celebrate that at each milestone it was the best it could be. But we should also spend more time looking to the future, working out how we can make today as good as it can be and tomorrow even better. This is the NHS at its best, preparing for the future, building on what is past but not beholden to it.

I read newspapers and I see a narrative about the NHS, a lazy narrative that says the NHS is not as good as it was, the NHS is failing, the NHS is being changed fundamentally from the vision and values of its founders, the NHS has turned into something Nye Bevan would not recognise.

None of this is true, apart from the last one. Bevan should not recognise the NHS now. If he did, he would be horrified that 60 years later nothing had changed. With 1 million patients every 36 hours, 20 calls a minute to NHS Direct, 600,000 people giving up smoking in the last year, 720 ambulance emergency calls an hour, and 23 million people using GP surgeries every month, the NHS of today is in rude health.

We should, as non-executives, say that more often, say it publicly and say it proudly. We should stand up for our NHS, not as it was, but as it is and as it will be. That is what we can influence and if we are not seeking the best now and better tomorrow, then we need to look at what we are doing.

On 5 July, I will raise a fruit juice to the founders of the NHS. I will say thank you and I will make a pledge that I will do everything I can to stand up for the NHS now, taking it back for the people from the established and destabilising media narrative, and I will look to tomorrow.

Readers' comments (5)

Anonymous | 30-Jun-2008 12:23 pm
Keith may be right about nostalgia but to say that "throughout its history, the NHS has been the gold standard, the service to which the world aspired" is simply not true. I have worked across Europe in healthcare. Of the big-5 EU countries the UK is generally considered to be the one NOT to be ill in.

Cost-managers do like NICE.

Still I am re-assured that our MRSA infection rate could not be better, that our midwife cover, cancer survival rates, recruitment system for junior doctors, sensitivity to patient needs, nutrition of older people, and availability of innovative cancer drugs could not possibly be better.

And I do think Keith Pearson could not be more complacent.
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Mike Swift | 30-Jun-2008 4:36 pm

"Things aren't what they used to be and probably never were" * & beware of rose coloured spectacles. But the glory of the NHS is that you can take your sick child to hospital without worrying about the cost. Lets keep that on the agenda or we might lose it. Apparently the most common causes of bankruptcy in the USA are medical bills.

*Will Rogers
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Anonymous | 30-Jun-2008 5:07 pm
I concur with the points made by Keith Pearson in the article. For a nationally funded health service to have survived 60 years, intact and still holding to the founding principles of free at the point of use is some achievement. To have done this and to have taken the public with it is quite remarkable. Yes, the NHS is gold standard and I am proud to shout that from the rooftop. The transformation that has taken place in the NHS in the last few years has prepared the NHS for tomorrow. Well done NHS and well done NHS staff.
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Anonymous | 1-Jul-2008 2:25 pm
The National Health System as a whole is something we should be proud of and it is right to celebrate the 60th anniversary. However, we should not be complacent there is so much more to do. I hope that Keith and his SHA Chair/CEO colleagues across the country will do more to put citizens in the driving seat - staff are public servants in their role but they should be valued as citizens too. Listen to what they have to say, front line staff have many of the answers and most of the experience. Remember Ministers, MPs etc have to be elected and staff in public service need to feel empowered to remind their public servants of their responsibilies.
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Anonymous | 2-Jul-2008 12:12 pm
Mike Swift wrote: "But the glory of the NHS is that you can take your sick child to hospital without worrying about the cost. Lets keep that on the agenda or we might lose it. Apparently the most common causes of bankruptcy in the USA are medical bills."

Do you believe that this is not true in: France? Italy? Spain? Germany? Sweden? The Netherlands? Norway? etc etc.

I am no defender of the flawed US system, but you should be aware that the 2005 Harvard study you are drawing on (quoted in Michael Moore's Sicko) has two major flaws:

1) A medical bankruptcy includes anyone going backrupt who has more than $1000 dollars in medical debts, even if most of their debts are non-medical. They could have $100,000 of student loans and $1,001 in medical debts and still be counted. Of course people getting into difficulty will stop paying lots of bills.

2) "Medical causes" were taken to include "uncontrolled gambling", "drug addiction", "alcohol addiction", "death in the family", and "birth/adoption of a child" which covers a lot more than "medical bills".

3) Only 28% of bankrupts in the study claimed that "illness or injury" was substantially a cause of bankruptcy - and that of course could include injuries causing inability to work, etc as well as resulting costs of treatment.

Medical costs can put US families in difficulty - but do not cause most bankruptcies.
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