A personal history of the NHS

Kenneth Calman looks back over the past 60 years describing the impact that the NHS has had on him

I was born a few years before the NHS began and have been part of its progress over the past 60 years. For me, it has been part of my life, and it has saved my life. This is a personal history from someone who has been a patient, a carer, a professional and policy-maker.

My first introduction to the health service, at the age of nine, was the death of my father, aged 41, from a heart attack. He was a heavy smoker and his death occurred a few months after Richard Doll first published his key work on cigarette smoking and health. His death had a profound effect on me and, as my interest in medicine grew, it was clear that this event could have been avoided, or treated more appropriately.

Fifty-five years later, in 2008, I had an aortic valve replaced in the same hospital. I received impressive care from high-quality staff - from the surgeons, anaesthetists, nurses, dieticians and physiotherapists, and the whole, wonderful team.

What has changed in between? What would have happened to my father now? The increased range and effectiveness of treatments and diagnostic developments has been quite astonishing. In my own professional lifetime, I have been involved in transplantation, cancer therapy, palliative care and public health. In each of these areas, the outcomes for patients are now just so much better. And these are just in the fields I have been involved in. Other changes in childhood illnesses, child birth, heart disease, and mental health have been equally impressive.

The healthcare team is now well established, with the contribution of a wide range of professionals well recognised. Managing resources and making the best use of skills and expertise is now part of the ethos.

The involvement of patients and the public is critical, as I learned in my time as a professor of oncology. Patients and their families have so much to offer. We need their help.

The community-based specialties, including general practice and primary care, community child health and mental health, have been major successes. The management of the NHS has changed many times. Indeed, I have suggested that on formal occasions we might wear our campaign medals, for the reforms we have been part of: 1974, 1984, 1989 and so on. Quality issues now dominate the agenda. Patients and the public want to know what will happen to them, what the outcome will be, and how that compares to other places. The watchwords are evidence-based, outcome-focused and quality-driven. Individual choice is important, and for some, quality of life may be just as important as length of life.

One of the most significant aspects of the past 60 years has been a huge improvement in public health. Standardised mortality rates in adults have dropped from 101 in 1950 to 57 in 2005. Infant mortality has decreased over the same period from 50 per 1,000 live births to 5 per 1,000 live births. In terms of individual diseases, for example breast cancer, the outlook is now significantly better, a 34 per cent reduction in mortality since 1989, with the introduction of screening, specialisation in cancer care, and improved treatment.

We have learned that health is determined by a number of factors, including our biological make-up, our environment, lifestyle, social and economic circumstances and the quality of our health services. It could be argued that health services (where most of the money goes) are the least important in improving overall population health. Employment, poverty and educational standards are all important determinants of health that continue to present challenges.

There are three other factors that have seen very significant changes over the past 60 years: the increasing relevance of research in showing ways to improve treatment and quality of life; the education of health professionals; and ethical issues, which are now seen to be increasingly relevant.

My first introduction to the health service, at the age of nine, was the death of my father, aged 41, from a heart attack

My final point is the important development, over the past 10 years, of devolved parliaments and assemblies. This has resulted in some significant differences in the ways in which health services and public health interventions are introduced, organised and delivered. These are healthy developments but, in the future, such differences may become more significant within the UK and policy-makers will need to think through the consequences. Their effectiveness, or otherwise, will need careful analysis.

To return to what would have happened to my father in 2009. First, I like to think that he would not be smoking. Second, with the role of primary care in identifying disease at an early stage, his condition might have been picked up earlier and prevention instigated. Finally, if he had collapsed at work in 2009, he would have had a better chance of resuscitation and acute treatment.

These are just some of the changes that have occurred over 60 years, and there are more improvements to come. However, in making such changes we should not lose sight of the fundamental principles of the NHS. The NHS is precious, it too needs care.

Sir Kenneth Calman is president of the British Medical Association and is a former chief medical officer

This article first appeared in the 02 February 2009 issue of the New Statesman, Interview: Alistair Darling

Getty
Show Hide image

The New Times: Brexit, globalisation, the crisis in Labour and the future of the left

With essays by David Miliband, Paul Mason, John Harris, Lisa Nandy, Vince Cable and more.

Once again the “new times” are associated with the ascendancy of the right. The financial crash of 2007-2008 – and the Great Recession and sovereign debt crises that were a consequence of it – were meant to have marked the end of an era of runaway “turbocapitalism”. It never came close to happening. The crash was a crisis of capitalism but not the crisis of capitalism. As Lenin observed, there is “no such thing as an absolutely hopeless situation” for capitalism, and so we discovered again. Instead, the greatest burden of the period of fiscal retrenchment that followed the crash was carried by the poorest in society, those most directly affected by austerity, and this in turn has contributed to a deepening distrust of elites and a wider crisis of governance.

Where are we now and in which direction are we heading?

Some of the contributors to this special issue believe that we have reached the end of the “neoliberal” era. I am more sceptical. In any event, the end of neoliberalism, however you define it, will not lead to a social-democratic revival: it looks as if, in many Western countries, we are entering an age in which centre-left parties cannot form ruling majorities, having leaked support to nationalists, populists and more radical alternatives.

Certainly the British Labour Party, riven by a war between its parliamentary representatives and much of its membership, is in a critical condition. At the same time, Jeremy Corbyn’s leadership has inspired a remarkable re-engagement with left-wing politics, even as his party slumps in the polls. His own views may seem frozen in time, but hundreds of thousands of people, many of them young graduates, have responded to his anti-austerity rhetoric, his candour and his shambolic, unspun style.

The EU referendum, in which as much as one-third of Labour supporters voted for Brexit, exposed another chasm in Labour – this time between educated metropolitan liberals and the more socially conservative white working class on whose loyalty the party has long depended. This no longer looks like a viable election-winning coalition, especially after the collapse of Labour in Scotland and the concomitant rise of nationalism in England.

In Marxism Today’s “New Times” issue of October 1988, Stuart Hall wrote: “The left seems not just displaced by Thatcherism, but disabled, flattened, becalmed by the very prospect of change; afraid of rooting itself in ‘the new’ and unable to make the leap of imagination required to engage the future.” Something similar could be said of the left today as it confronts Brexit, the disunities within the United Kingdom, and, in Theresa May, a prime minister who has indicated that she might be prepared to break with the orthodoxies of the past three decades.

The Labour leadership contest between Corbyn and Owen Smith was largely an exercise in nostalgia, both candidates seeking to revive policies that defined an era of mass production and working-class solidarity when Labour was strong. On matters such as immigration, digital disruption, the new gig economy or the power of networks, they had little to say. They proposed a politics of opposition – against austerity, against grammar schools. But what were they for? Neither man seemed capable of embracing the “leading edge of change” or of making the imaginative leap necessary to engage the future.

So is there a politics of the left that will allow us to ride with the currents of these turbulent “new times” and thus shape rather than be flattened by them? Over the next 34 pages 18 writers, offering many perspectives, attempt to answer this and related questions as they analyse the forces shaping a world in which power is shifting to the East, wars rage unchecked in the Middle East, refugees drown en masse in the Mediterranean, technology is outstripping our capacity to understand it, and globalisation begins to fragment.

— Jason Cowley, Editor 

Tom Kibasi on what the left fails to see

Philip Collins on why it's time for Labour to end its crisis

John Harris on why Labour is losing its heartland

Lisa Nandy on how Labour has been halted and hollowed out

David Runciman on networks and the digital revolution

John Gray on why the right, not the left, has grasped the new times

Mariana Mazzucato on why it's time for progressives to rethink capitalism

Robert Ford on why the left must reckon with the anger of those left behind

Ros Wynne-Jones on the people who need a Labour government most

Gary Gerstle on Corbyn, Sanders and the populist surge

Nick Pearce on why the left is haunted by the ghosts of the 1930s

Paul Mason on why the left must be ready to cause a commotion

Neal Lawson on what the new, 21st-century left needs now

Charles Leadbeater explains why we are all existentialists now

John Bew mourns the lost left

Marc Stears on why democracy is a long, hard, slow business

Vince Cable on how a financial crisis empowered the right

David Miliband on why the left needs to move forward, not back

This article first appeared in the 22 September 2016 issue of the New Statesman, The New Times