The only duty we owe history is th rewrite it. Oscar Wilde, The Critic as Artist 1891.
Aneurin Bevan (A.B.) was the founder of the NHS in 1948 and it is well worth reading his “In place of fear” published in 1952. Chapter 5 is an inspiring read, and Bevan warns of the dangers of regionalism (now post code lottery). If you would like to read the whole book the chapters are all available on line.
(I don’t think A.B. thought enough about the Perverse Incentives (PIs) inherent in a system with no encouragement of autonomy, and no rationing : A house built on sand. In this regard, the NHS is comparable with motor insurance, without any loss of no-claims-bonus for accidents, and no excess (co-payment) by which the policy holder pays for the first financial level of the claim.) The Nursing Times has its own page and slant on the birth of the NHS.
The NHS was preceded by Insurance based schemes for those who could afford them, but many were excluded (The Guardian 7th October 2011).
A lecture on the Origins of the NHS is available from 14th April 2008 given by Prof. Virginia Berridge (Professor of History and Director of the Centre for History in Public Health at the London School of Hygiene and Tropical Medicine, University of London.)
Quote: “poverty will use democracy to win the struggle against property, or property, in fear of poverty, will destroy democracy” Aneurin Bevan.
Bevan looked at locality differences and commented… “But no local finances should be levied, for this would once more give rise to frontier problems; and the essential unity of the Service would be destroyed.(note 7)” I wonder what he would think of differential prescription charges, nursing home rules, infertility treatment access etc etc.
The NHS has been re-organised ever since it began. Prescription charges followed charges for Optical and Dental services. There was a new contract for GPs in 1966, and following this small single handed men practicing from their own homes, became larger group practices with equal numbers of men and women, modern purpose built premises and computerised recordkeeping. Another new contract followed in 2003 , and was operational in 2004, and the continuing changes (Pulse 18th March 2013 – 2014 contract changes) have meant more and more performance targets, less and less continuity of care, and a straightjacket which most GPs resent. Indeed feel that, although technically self employed, they have most of the disadvantages of being salaried, without the sensible hours. The Telegraph reported 18th March 2013 that Ministers ‘were ploughing on regardless’ with GP contract reform.
Experimentation with FundHolding (abolished without evidence of failure) under Margaret Thatcher’s conservative government ended when Labour won the election in 1997, and retrospectively monies saved by GPs were repatriated to the least efficient bodies, the Health Authorities.
Performance Indicators began in 1998 with smears and immunization targets for GPs, and have multiplied since. Targets for Accident and Emergency departments, along with Out Patient and operation waiting list targets. The Kings Fund does not feel this is necessarily good or needed, and the targets certainly take away local judgement.
Hospital consultants used to run their departments. Nursing Sisters used to run their wards. A theme emerging from the first interviews is that they are disengaged and that re-instating them in the roles they had years ago would be popular among both professions. I am unsure as to when this power to make a difference was taken away… I am sure someone will let me know….
The Kings Fund reports declining confidence over many years in the NHS. Has the sandy foundation, without rationing, finally been realised?
The Nuffield Trust has an informative Timeline for the NHS.
Human History becomes more and more like a race between education and disaster. H G Wells. The Outline of History 1920.