Abstract
Prof Maynard's essay
1
prompts me to make the following comments: The Lloyd George model of health services survived till after the war. The tripartite NHS survived almost 30 years. It worked well (I say as a patient and as a doctor in the system). 1974 saw the birth of a unified NHS. Despite the advice of the Royal Commission to let things settle down, the government abolished the Areas and created Districts (in 1982). In 1985, the government brought in ‘General Management’. From then on there have been so many changes – perpetual motion – that the NHS staff must be suffering travel sickness. Before cutting services, we should find the ‘Efficiency Savings’ that both the Conservative and the Labour experts have been claiming are achievable. One wonders, though, why the Labour Government did not govern more efficiently. More information? Look at the money spent on creating information and data systems in the mid-1970s and the manpower (Human Resources they call it now) to service it and then see if you can justify throwing more good money in to the bottomless pit. More competition? Please let the doctors do the doctoring, the nurses do the nursing and administrators do the administering. They should not be constantly looking over their shoulders to see who is operating faster, kicking the patients out faster. And if the nurses can do the doctoring, then they should be paid as much as the doctors. If this is the shape of things to come, then we should be shutting down some medical schools. Remember the days when there were ‘cold hospitals’, hospitals with mixed acute and long-stay patients, acute hospitals with higher physical and emotional workloads for the staff? Nursing staff could and did move around in the ‘hospital group’. Junior doctors sometimes spent six months or a year in the ‘cold hospitals’ reading for their exams. In those far-off days, I recall, there was not quite so much stress.
Footnotes