The general election and the NHS -May 2010

I didn’t want to start on a political subject straight away but the announcement of the general election has made me reflect on the coverage of health care and the debate about taxes, public services and how we choose to pay for the services that we have.

I was in my third year of medical school in 1979 when Margaret Thatcher and the Tories were elected. For nineteen years I saw a gradual decline in the fabric of the NHS – both as a practising doctor and as a user of the health service – my children were born during this period. I witnessed the worst of the NHS and the best. I can still remember transformative experiences – for example the occasion when a tramp was brought in after an accident and the way that no expense was spared to treat him. The dignity with which he was treated, and the way in which the top specialists and nurses looked after him had a profound influence on me. No one asked where he came from, who he was and whether he deserved the treatment. He was a human being in need of help and he received the best care that money could buy. There was no better example of what was meant by a  health service, free at the point of need and available to all  irrespective of background.

However, I also saw patients suffering in pain and not being able to get an operation for hip replacements because of huge waiting lists. I saw patients denied renal dialysis because they were deemed to be too old at 65 years of age. I’ll never forget in 1996 receiving a letter from a consultant to whom I had referred an eighty year old patient for a cataract operation, telling me that the waiting list was 18 months long and that if she was still alive in 18 months time then he would consider operating on her. We could never organise tests such as ultrasound scans, MRI scans and echocardiograms for our primary care patients. And I also saw doctors benefiting from this state of affairs – private practice was booming as patients and their families were forced to consider private treatment so that they could get basic (and in some cases) lifesaving treatment. I also saw the terrible impact of unemployment and child poverty.

The situation is now transformed beyond all recognition. My patients rarely wait more than 8 weeks for most operations. As a GP I can refer patients for MRI, ultrasound and CT  scans which are done within 2 weeks. Patients with suspected cancer are seen within two weeks of referral and most are started on treatment as soon as the diagnosis is made. Private practice has virtually disappeared. Of course there are problems but for my patients living in one of the most deprived areas of Manchester, the NHS is living up to what it was meant to be.

So I get very angry when I read about ‘how all the investment in the NHS has been wasted’. People seem to have very short memories. We seem to want it all but don’t want to pay for it through taxes. We have spent billions rescuing the banks and have seen inequalities increase (see the excellent website http://www.equalitytrust.org.uk/) and seem obsessed with cutting non-existent waste and talk about painful cuts as though the consequences of higher unemployment and increasing child poverty are something that we just have to put up with. It’s galling to see so-called business leaders – some earning millions of pounds per annum giving us lectures on the need for austerity.

Perhaps I am preaching to the converted but I think it is worth reflecting on the past, on our priorities and asking ourselves whether as the fourth richest country in the world we could do better. As doctors we can’t ignore the social impact of these policies, and dare I say it, we can’t ignore the politics – it’s not good enough to say that all politicians are the same. The founder of the NHS, Aneurin Bevan was reported to have said ‘the language of priorities is the religion of socialism’.

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