The NHS at 70

Moira Petty / 18 May 2018

2018 is the year the National Health Service hit 70; to celebrate, we spoke to doctors, nurses and patients about the nation’s best-loved asset.



The patients

For 13-year-old Sylvia Beckingham, being treated for liver disease in a Manchester hospital, 5 July 1948 brought flashbulbs and a parade of important figures to her bedside.

She was deemed to be the first patient of the newly launched National Health Service. Its architect, Labour’s Minister of Health Aneurin Bevan, swung by in a publicity blitz that had already seen 94% of the public enrolled. 

The free-at-the-point-of-delivery service vanquished the fears of the less well-off that an operation or even seeing a doctor might plunge them into debt.

Sylvia, who died in 2006, understood the importance of that summer day. Over at Farnborough Hospital in Kent, student nurse Teresa Morley (then Whyte) acknowledged its significance while getting on with her tasks. 

‘We were so much more hands-on then,’ says the 89-year-old from Alton, Hampshire. ‘We did bed baths, helped with feeding, syringed ears and gave enemas.’ The ward ran on discipline. ‘When matron appeared, a ripple ran through the place.’ Crisp uniforms, starched aprons, white hats and different coloured dresses helped patients identify the various ranks. 

‘We were taught to care for patients. We took it in turns to sit with a young woman who was dying. Afterwards, I went into the sluice room to sterilise bedpans and burst into tears. Sister came in and told me I had to be strong. As I became more senior, I would never let a patient die alone.’

The patients would often stay in for long periods, as drugs and techniques to speed up recovery times were not yet available. ‘That was how I met my husband, Alan, who was in for eight days after having his appendix removed,’ Teresa recalls. ‘Sister said it was nice to have a young man in for a change, but I was careful not to take too much notice of him.’

Christine Horner, now 73, of Cleckheaton, West Yorkshire recalls lying in an iron lung as a four-year-old, one of many affected by the 1949 polio outbreak. ‘It was like a metal coffin,’ she says. ‘All I could hear was the whoosh of the five iron lungs in my ward, pushing air in and out. There was a mirror above my head so I could see the nurses.

‘It upset me that my family could only visit for one hour, three days a week. After three months, I was moved to a chair, my head hanging down to my shoulder. The nurses were nice, but we weren’t encouraged to play with the other children. We were given smelly veg to eat, such as sprouts, the ward was bland, and my stay was grim.’ 

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The doctors

Christine wouldn’t have known about the punishing schedule of Junior doctors, such as Peter Toghill, who qualified in 1955. ‘It felt like we were working 24/7, with one weekend off in six,’ he says. By contrast, some of the consultants, so rich from private practice they didn’t take an NHS salary, would be driven up to the hospital door by their chauffeur. ‘They would hand umbrella and hat to the porter and be greeted by the team to whom they were “Sir”. The more lofty and arrogant they were, the more the patients liked it.

‘We juniors repaired hernias, removed appendices, often beyond our expertise. There was continuity of care, though. Unlike now, we’d see a patient’s illness from start to finish and they thought of you as “my doctor”,’ says the 86-year-old retired Nottingham consultant physician. There could be some chilling brusqueness in doctors’ bedside manner, though. ‘One was heard on the phone saying: “The breast lump you had removed: it’s cancer, I’m afraid,” and down went his receiver.’ 

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Judith Saunders, 73, a former physiotherapist who qualified in 1966 in Bradford, says she was ‘a Jack of all trades’ with little autonomy. She was instructed by the consultant in short notes, stating ‘heat and exercise’ or ‘massage and exercise’. 

‘Surgeons in the 1960s would stand at the bottom of the bed and say, “Mr Parker, we’re going to remove your leg tomorrow,” and move on. That was before improved drugs for poor circulation. 
‘People who’d had a cancerous lung removed would have massive scars like zips. We’d massage them and they’d almost purr. A broken leg meant traction for months. I would bring a record player up to the ward with pop records and the whole ward would sit up in bed and do their exercises.’ Aged 21, she worked in a geriatric hospital. ‘The old ladies weren’t very ambulant or fit. They were institutionalised, some sent there decades earlier for having babies out of wedlock.’

While physiotherapy in the 1960s was chiefly a female calling, women doctors were in a tiny minority, contrary to current trends. Dr Eleanor Arie, 77, qualified in 1965 and rose to be a consultant rheumatologist in Norfolk. She had the first of her three children while on rotation as a trainee GP. 

‘I got a week off before the birth and seven weeks afterwards. I took the baby with me on home visits, resulting in her getting a few sore throats. One professor told me: “Your place is in the home”.’ 

By contrast, Professor Tom Treasure, 70, who retired as a consultant cardiothoracic surgeon at Hammersmith Hospital and now researches at University College, London, saw the NHS change for the better. ‘When I started, the mortality rate for heart surgery was 20%. The unit did about four such operations a week, compared with twice that in a single day now. You counted heads and if all were still alive at the end of the week, you were up to par. A decade on, the risks were down to 5%. There was a lot of excitement in the theatre with developments going on in front of our eyes.’ 

When he began, the age limit for many cardiac procedures was around 60. ‘By the 1980s I was asked to do an aortic stenosis op on a 90-year-old. He told me that he wanted to go to Canada to see his sisters, aged 102 and 103. We operated and, the last we heard, he was off on his trip.’

Back in 1974, former General Medical Council chair Professor Sir Peter Rubin was a junior doctor in Stoke-on-Trent. ‘The NHS had a long way to go then. I saw cases I’d only read about in textbooks, people with undiagnosed TB, an anaemia patient dying in front of me in A&E. Pregnant women with high blood pressure were put to bed for 22 hours out of 24 and given barbiturates. When I asked for the evidence, I was told, “Well, it works”.The views of important specialists held huge weight then. What’s changed radically is evidence-based medicine with clinical trials.’

He was overseen by ‘old-school’ consultants, who insisted on keeping patients in the dark. ‘I was driving home one wet afternoon when I turned back and went to see a cancer patient of my age – then 26. He was grateful for my honesty about his poor prognosis and never let on to the consultant. That was how I wanted to practise as a doctor.’

He worries, though, about patients’ expectations today. ‘They have become more unrealistic. If you’re seriously ill, the NHS will come up trumps. It’s with the troublesome but non-life-threatening cases that the NHS struggles.’

Caron, 57, a senior midwife in a south London hospital, has seen another concerning modern trend: rising numbers of mothers-to-be diagnosed with diabetes. ‘We have gone from a couple of women a year in the 1990s with Type 2, to 50 last year, due to better testing but also lifestyle choices. This creates high-risk pregnancies.’

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The incredible advances of modern medicine have brought with them ethical dilemmas. Professor Lynne Turner Stokes, 63, who became a doctor in 1979, is director of the Regional Rehabilitation Centre at Northwick Park Hospital in London, which deals with patients with major injuries. ‘The NHS is now rescuing patients who would have died at the roadside five years ago. Some have made remarkable recoveries, such as the patient who was minimally conscious and now, although largely confined to a wheelchair, is able to go sailing and water-skiing.’

Head and neck cancer consultant surgeon Julian McGlashan at the Queen’s Medical Centre, Nottingham, sees the flipside of treating more patients. ‘My clinics overrun because I give people the time they need,’ says the 58-year-old, who qualified in 1983. ‘Surgery is actually the least stressful part of my week.’ A recent beds shortage means he has a backlog of non-urgent cases. ‘It’s no longer a winter-only crisis.’ 

Consultant anaesthetist Dr Daniel Morland, 42, is ‘Danny’ to his patients at the Royal Victoria, Newcastle. ‘Being called “doctor” skews the working relationship with patients. It’s best to work as if they are a customer. They tell you what’s wrong and you tell them what you can provide.’ 

He qualified in 2001 when junior doctors no longer worked all weekend but in 12-hour shifts. Techniques such as 3-D imaging meant that a lot of data was gathered quickly, plus there was a high turnover of patients. ‘It was hard to get the hang of assimilating it all.’

Patients can breathe a sigh of relief that junior doctors are better looked after now. ‘There is a lot more supervision. I worry about staffing levels, though. They come out of medical school with £80,000 worth of debt. Is it surprising they go to Australia or New Zealand?’

In some disciplines, there is a move back to primary care. Physiotherapist Luke Tobin, 22, from Devon, says: ‘We work in community settings as well as hospitals, treating patients at the first point of contact, such as in GPs’ surgeries.

‘The philosophy is “the most amount of impact with the least intervention”. Physiotherapy isn’t about massage. It’s becoming less hands-on. We instruct the patient, who goes away and does it.’
Jeremy Jehu, 62, an author, experienced the NHS last year. ‘I briefly lost the vision in one eye and went to A&E at Moorfields Eye Hospital, London. There was one doctor for dozens of people and it took seven hours before I was told that something had blocked the flow of blood to my left eye.’ After that, though, he was fast-tracked to University College Hospital’s stroke unit for treatment on a blocked artery to the brain. 

‘I was given so many scans and tests that I was almost embarrassed at the attention I got. I never had the sense that, as a bloke with no dependants, I was low on the NHS’s list of priorities. I was sitting up in bed 90 minutes after surgery; the nurses were marvellous and even the food was enjoyable. This was the NHS at its best.’

NHS timeline

July 1948 
The NHS is launched, bringing hospitals, doctors, nurses, dentists and pharmacists together to provide free treatment for everyone, funded from taxation. 
1952 
Prescription charges of 1/- (5p) and £1 for dental treatment introduced.
1954 
Children allowed daily hospital visits after paediatricians warn how traumatic separation from their family is.
1958 
Vaccine for polio and diphtheria introduced – the NHS is pioneering good health as much as treating illness.
1961 
Contraceptive pill made available to married women, and to others in 1967.
1962 
Prof John Charnley carries out the first full hip replacement – with most of his patients agreeing he could have the prosthetic back when they died to help research.
1978 
The world’s first ‘test-tube’ baby, Louise Brown, is born.
1979
First successful UK heart transplant carried out.
1980s 
First use of keyhole surgery and the introduction of MRI scans. 
1991 
The first 57 NHS Trusts are created.
2000 
NHS walk-in centres set up. 
2017 
Next Steps report focuses on improving care while easing strain on the system.

Looking to the future

The NHS has changed radically throughout its 70-year history but it must reinvent itself to keep faith with a public that believes in its core values, according to Richard Murray, director of policy at health charity, The King’s Fund. 

‘The way the health service delivers care has to adapt to reflect the needs of society. The UK has an elderly population and many more people with multiple long-term conditions that we cannot cure but can ameliorate.

‘We must change the system to help people look after themselves, using the hospital as more of a backstop when things haven’t worked.’ He envisages: ‘Better primary care; both prevention and more light-touch, supportive care in people’s own homes. The distinction between health and social care in this country looks untenable. They need to work together and other groups, such as volunteers, will be needed to help with care.

 ‘On finances, particularly for its workforce, the service is facing its greatest challenge in decades. The NHS might be forced to change in ways people won’t like. Specialist cancer surgeons reserved for the more complex cases, rather than treating those with early diagnosis, for instance.

‘Technology still seems to be untapped in healthcare: some areas of mental health provide virtual access for patients, via video or Skype consultation. It could change things in wholly unexpected ways.’

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