Alice Miles
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I am looking at a leaflet informing the public about the creation of the National Health Service, almost 60 years ago. The celebrations for this anniversary begin at the end of this month. There will be a party at Wembley Stadium, a service of celebration at Westminster Abbey, and countrywide events, most of it organised by the Department of Health in Whitehall.
Never underestimate the desire of politicians to lay claim to the NHS. For many years it was a “Labour” achievement, its strongest stick with which to beat the Conservatives. And when the next election comes, the NHS - the fate of the local hospital or GP surgery - will still account for far more votes than any esoteric arguments about 42 days' detention, or EU or climate change treaties.
Labour will suck every piece of political capital it can from the 60th anniversary party. By chance, as I write this, I receive a voicemail from Labour HQ asking whether I plan to write about the anniversary in the next fortnight. “Health ministers are very keen to start laying out where the NHS needs to go in the next few years” and one of them would be very keen to have a few words with me... The debate on polyclinics, the press officer adds, “is one very clear dividing line on modernisation”.
Poor old health service, batted from party to party, from election to election. I turn back to that leaflet from 1948: “Your new National Health Service begins on 5th July. What is it? How do you get it? It will provide you with all medical, dental, and nursing care.” And a very clear dividing line on modernisation in 60 years' time.
All medical, dental, and nursing care... you don't even need to ask the question to know that the NHS could never claim that today. NHS dental care is patchy at best, medical care is heavily rationed, and nursing care, as anyone who has spent time in hospital will tell you, is hit and miss. In part, this is due to greater demands on the health service. Whatever it offers, we want more: more treatments, more consultations, more medicine. More care. Demand has always taken the politicians by surprise: Nye Bevan estimated the initial cost of the NHS at £176 million for 1948-49. Its first full year of operation came in at £437 million.
Today we want the service to meet an ever-expanding definition of health. We want it to make us happy as well as healthy, fertile as well as fit. One day we will expect it to make us beautiful, perhaps even successful too. No wonder it is still struggling on its £90 billion annual budget.
It isn't only the fault of the patients. The officials and the politicians who run the NHS have lost sight of what they are there for. Look at the current campaigns listed on the DoH website: “know your units”, “top tips for top mums” (including “top tips from Patsy Palmer” of EastEnders), and my favourite “Catch it, Bin it, Kill it”, a campaign to encourage the public to practise “correct respiratory and hand hygiene when coughing and sneezing”. The NHS waggles its finger at us, naughty children. Put your hand in front of your nose when you sneeze! It has turned into mum.
When it doesn't admonish, it consults: yesterday the department sent hospitals tens of thousands of surveys to track patient satisfaction with the patient choice programme. And when it doesn't consult, it issues edicts: June 12, 2008 - “The NHS Resilience and Business Continuity Management Guidance 2008: interim strategic national guidance for NHS organisations.” Poor guys. No wonder the best managers in the NHS are the ones who know which Whitehall edicts to file immediately in the bin.
Time after time patients tell the politicians that what they want from the NHS is what the NHS promised at the start: access to high-quality medical care (in clean premises) as and when they need it.
Now the greatest risk to the health of the NHS is approaching: the march of the alternative health industry. This week came the publication of the “Report to Ministers from the Department of Health Steering Group on the Statutory Regulation of Practitioners of Acupuncture, Herbal Medicine, Traditional Chinese Medicine and Other Traditional Medicine Systems Practised in the UK”. Otherwise known as twaddle. What it said is that government should regulate alternative therapies from acupuncture to Ayurveda.
It's the latest step by the alternative health industry, spearheaded by the Prince of Wales, towards official recognition by the NHS. Their problem: doctors see no scientific merit whatsoever in most of the “treatments”. Research by Edzard Ernst, a professor of complementary medicine, has found the majority of alternative therapies to be clinically ineffective, and many dangerous.
Regulate the practitioners - for safety, note, not for efficacy, as that is impossible to prove - and you give them official recognition. From recognition it is but a short hop to demand and then prescription: packet of Prozac, bit of yoga and a bag of dodgy herbs for you, sir. Britons already spend billions on alternative medicine; how much more could they spend when it is public money floating down the colonic canal? Free massages and maharishi ayurveda for all!
And imagine the bonanza in work for the Whitehall bureaucracy, as the British Association of Accredited Ayurvedic Practitioners grapple for dominance over the Maharishi Ayurveda Physicians' Association (none of these is made up). Question 10 of the consultation document preceding Monday's report read: “Would it be possible for the herbal medicine traditions of Kampo and Tibetan herbal medicine to be individually represented on Council?”
The Government responded on Monday - with a three-month consultation. So join in. Write to the Health Minister Ben Bradshaw at Richmond House, 79 Whitehall, SW1A 2NS. Write, on behalf of the NHS: “What I want for my 60th birthday is... the chance to provide medical, dental, and nursing care to all. And absolutely nothing else.”

Alice Miles has been with The Times since 1999. She began as a Parliamentary Sketch writer before becoming a columnist, writing mainly on politics and national issues such as education and health. She won Columnist of the Year in 2007.
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I have a radical idea.
Cut the NHS down to essential care only and privatise the rest. 10% of the saved £90 billion could be spent on insurance for those who cannot afford it. Cut national insurance in half and make it illegal not to have medical insurance. Independant database to see who has it.
Nick Mackenzie-Rowe, Halesowen, England
The scale of the NHS is such that if the whole of the workforce voted for labour then no other political party would ever get elected. Scary thought!
mike lincoln, wakefield,
Bravo, Alice- but alt.therapy is already accessing the NHS. As an RD I see pts needing treatment for the side effects of their alt.treatment. Kidney toxic herbs, growth failure in autistic kids, chronic diarrhoea from OD'ing on vits, likely coma from ephedra - it's already costing the NHS money. .
Catherine Collins RD, Epsom,
We dont need more nurses!
We need Nurses that are left alone to do the job that they are well paid to do.
We dont need more matrons,we already have layer upon layer of management in the NHS.
We dont need a deep clean and all that that implies.We need existing staff to cut the attitude and work.
Graham, Bishopbriggs,
Couldn't agree with you more.... Why is it we can see it and they can't? Because of the vested interests in the medical profession.
"What's needed today is a very large pair of scissors to cut the NHS down to all but vital care. Leave people to get prescriptions for a 'better' life elsewhere.
Angela Maureen Bayley, Bettws y Crwyn, UK
I fail to recognise the comment that big business has taken over the NHS. Any business that ran itself along the same lines as the NHS would be out of business in a heartbeat.
It has reached Dickensian propotions - you only use the NHS as an absolute last resort and avoid it totally if you can
Morse, Oxford,
It's terribly easy. Sack one 'Trust Communications Officer'. Employ another doctor. Sack a 'Customer Satisfaction Auditor'. Employ a nurse. Sack a 'Process Quality Control Facilitator'. Hire two cleaners. Sack a 'Patient Community Liaison Manager'. Open another bed. And so on. Rocket science?
Dr Roddy Campbell, Christchurch, New Zealand
If alternative medication is really something the NHS should offer, will a cancer patient who pays to visit a herbalist get their treatment withdrawn? Or is it only effective treatment one is not allowed to buy for oneself?.
Jamie, Bolton, UK
Thank you Alice, some sense about the nhs at last! The government has increased demand enormously with its opening hours crusade, nhs direct, walkin clinics etc. A patient now expects to get advice for the slightest complaint from a number of different sources at any time of the day or night.
sarah, york, uk
Its not Ayurveda which is inefficient but the British government should regulate quacks who gain access ,claiming them as "Vaidyas"(Ayurveda doctor).You can reach London in many ways so do health,the patients must be given the choice to choose their way of health rather than forcing them!
Anil Xavier, Trivandrum, India
Guess what; it is a good idea to sneeze into a tissue and properly dispose of it.
Public health relies on the responsible behaviour of the public.
I note with sadness that spitting in public seems to becoming more common.
Where do you think HCAIs come from?
Richard Boyce, Haywards Heath, UK
Big Business has taken over the NHS in all but name !!!! I remember one administrator and one matron running a hospital and boy did they run it effectively and efficiently !!!!!
Nye Bevin's wife Jennie Lee used to represent a nearby town to me called Caannock. She's be turning in her grave now !!
ian payne, walsall,
I am already doing my bit to subsidize the NHS. I haven't been near a GP since being cured by a homeopath of serious illness years ago. I now use their services from time to time to keep me in good health. I pay my N.I. and I pay a very modest fee for my healthcare of choice. I am happy with that.
J. Cherry, Bournemouth, UK
Some prioritising would help. Figure out which programs are "nice to have", which are "got to have" and which are somewhere in the middle. Set the budgets accordingly.
Michael, Pueblo, Colorado, US
An ounce of prevention is worth a pound of cure. Money spent on education and prevention is well worth it. Otherwise I agree totally. What's needed today is a very large pair of scissors to cut the NHS down to all but vital care. Leave people to get prescriptions for a 'better' life elsewhere.
S. Black, Portsmouth,