As the NHS prepares to celebrate its 70th birthday tomorrow, we invited health workers and patients to give it a health check

THE NHS is 70 tomorrow. That should be cause to celebrate - especially as the health service was recently given a much-vaunted 'birthday present' in the form of an extra £20 billion a year by Theresa May's government.

But is it? We invited people who work or have worked in the NHS to give the health service a 70th birthday 'health check'. And the results are deeply worrying. A picture emerges of an NHS in crisis, crippled by underfunding, over-regulation, ever-growing demand and an unwieldy and wasteful purchaser/ provider split. On top of everything else, the growing cost of medical negligence claims threatens to swallow up the entire health service in future if something is not done.

Here is what they had to say:

YORK GP DR DAVID FAIR of the Jorvik Medical Practice

Is the NHS in good health as it reaches 70?

No, it is close to dying because of the failure of successive governments to invest in infrastructure such as buildings, IT systems and staff training. Staff are demoralised by over-regulation, over-work, poor training, and lack of appreciation from the management tiers. Buildings are frequently outdated and dirty. IT systems are laughably obsolete. We depend on foreign NHS staff because we have failed abysmally to train and retain staff in the UK.

York Press:

Dr David Fair

What works well about the NHS?

The clinical staff give so much unpaid, thankless, unacknowledged overtime and goodwill, the NHS seems to survive on their professionalism alone. The concept of universal free health care at the point of need is an ideal which inspires us all.

What are the problems?

The purchaser-provider split was political dogma introduced in 1992 where 'money follows the patient'. It was intended to make the NHS more efficient but it has failed because the politicians have never understood that you cannot measure the success of a service the same way you measure the success of a retail park. Now there are more managers and accountants in the NHS than ever before, employed to drive up “efficiency”.

There are private providers on the fringes of the NHS ready to pick off the easy work for profit, but when they are involved they cut corners, avoid staff training and communicate badly with the NHS so the whole care system fragments.

The lack of investment in infrastructure is because politicians see no further than the next General Election. Accountants see no further than the end of the financial year. There needs to be a 15-20 year strategy for the NHS - it takes 10 years to train a GP.

The future cost of medical negligence litigation and payouts threatens to swallow the whole NHS budget if the rising trend continues.

Is it financially sustainable as we live longer?

The NHS is the biggest computerised database of health care on Earth. If the data were anonymised and analysed, the information yield to other countries would be a very valuable saleable asset.

There is still massive waste in the NHS as most subcontractors and pharmaceutical companies see the NHS as an easy target.

The NHS has to be financially sustainable as the alternative would be a system where the poor and vulnerable suffer needless illnesses. Private health care systems cost more than nationalised health because private care has to generate a profit for shareholders.

The huge budget increase announced recently contains no provision for improving infrastructure. Once again it was about trying to shore up a failing system rather than investing in a future NHS.

Prescription to survive another 70 years.

1. Every NHS manager should have trained in a health profession before turning to management.

2. Elected MPs should vow to use the NHS exclusively if they get ill.

3. The overall NHS strategy cannot be decided solely by the Government.

4. Remove the purchaser-provider split to let professionals make decisions for best care, not cheapest care.

5. The general public must hold every politician to account at every election and ask: 'What have you done for the NHS?'

Dr BOB ADAMS, retired consultant psychiatrist at Bootham Park

I have spent my whole career working for the NHS. I started off as an auxiliary nurse, and then trained as a doctor in London before ending up working as a consultant psychiatrist in York. The NHS has been my family. It is sad to see what has happened to it in recent years.

Is the NHS in good health as it reaches 70?

Years of underfunding, misguided attempts at re-organisation and changes of management have taken their toll resulting in an over-stretched service currently at breaking point. But the NHS is not like a person in the twilight of their years. It can be given a new injection of life, if only the prescription is right.

York Press:

Dr Bob Adams

What works well about it?

The NHS is a marvellous institution gathering together dedicated and caring staff who want to improve the lot of others. Its strength is its staff. The NHS gives the population of Britain security so that whatever is wrong with you, and whatever your financial and social background, you will get good and up to date treatment and care, without having to worry about whether you can afford it.

What are the problems?

Underfunding is the first issue. The proportion of GNP spent on health services in the UK is now one of the lowest in Europe, and the situation is getting worse due to the recent policy of austerity. But the problems are not only due to underfunding. Since the so-called ‘internal market’ was set up in the 1990s a huge bureaucracy was set up to administer it. This bleeds billions of pounds from front line services every year. Each successive new government has then re-organised the management structure creating further problems and further wasting of money. On top of this there has been a policy by successive governments to privatise certain services. Private services are businesses whose main aim is to make a profit for shareholders.

Is the NHS financially sustainable as we live longer and place more demands on it?

Not at present. What is needed is a long-term view. The baby boomers, of which I am one, will increase the proportion of elderly people for another 20 to 30 years, but this population change will not be there forever. If the correct decisions are made now, one of which must include a large increase in funding, the NHS can be brought back from apparent terminal decline.

What is your prescription to ensure that the NHS can survive for another 70 years?

1. Abolish the purchaser-provider split.

2. Stop privatising services.

3. Decide what the NHS should provide and what it should not and take responsibility for this decision rather than hiving off responsibility to local providers. This means having a central policy that makes these difficult decisions in a fair and effective manner not swayed by political opinion.

4. Increase funding, perhaps through a special tax.

5. Develop a system of fair and effective social and community care for those who need it. Hospital admission should not be the fall back when it is not required.


ROSA Barnes is a happy teenager with her hair braided in long plaits and a cheeky sense of humour.

When she and her mum Helen were in a café recently she urged her mum to start jumping up and down as if she were on a trampoline. "She likes a laugh!" Helen said. 

Rosa was only able to ask her mum to start jumping, however, thanks to an expensive piece of kit supplied by the NHS. Rosa has Rett Syndrome, a rare genetic disorder affecting mainly girls. Rosa is a wheelchair user with difficulty talking.  

She does a great line in facial expressions, which is how her parents and her teachers and carers at Applefields School can usually tell what she's thinking or what she wants. But now, thanks to a new 'eye-gaze' tablet computer provided by the NHS, Rosa can communicate directly: asking her mum to jump, or telling her teachers or carers when she wants a drink of water.

The teenager directs her eyes at symbols on the tablet's screen, and the eye movement is  translated into speech using a synthesiser.

York Press:

Rosa Barnes, centre, with her eye-gaze tablet that helps her communicate. With Rosa are, l-r: speech and language therapist Suzanne Thurling, health care assistant Hilary Clayton, physiotherapist Helen Ryan and nurse Liz Davies

It isn't quite the first time Helen has heard her daughter speak. Like many children with Rett Syndrome, Rosa developed normally until she was 14 months old, before losing many of her skills. But the tablet has given Rosa a new independence in communicating - so she can ask for a glass of water when she wants one, instead of having to wait for someone to notice.

It has also allowed her cheeky sense of humour to shine through, Helen says.

The new tablet isn't the only way in which the NHS has helped Rosa. She also suffers from diabetes and epilepsy - and the NHS has been there for her all her life, Helen says.

At Applefields, there is a physiotherapist who ensures Rosa's wheelchair is comfortable, and a nursing team who manage her diabetes and epilepsy. In addition, the diabetes and epilepsy teams at York Hospital provide ongoing support, and a consultant paediatrician holds regular clinics at the school.

It has been like that all of Rosa's life, Helen says gratefully - the NHS has always been there. The family has an arrangement with the hospital so that if they are ever worried, they can call for advice, and either be given reassurance, or be told to bring Rosa in.

Without the NHS, Helen, from South Bank, doesn't know what she would have done. "It is amazing," she said. "They (NHS staff) do a fantastic job."

Which makes it all the more distressing for her to see the problems the NHS is facing.

With people living longer, it is facing greater pressures than ever, she says - and yet is has been starved of resources by a Government which she believes would like to see it privatised: a Government which talks about wanting to recruit more nurses, but then cuts nursing bursaries.

Morale is low, with staff often not kept informed about the latest changes. "I have noticed the strain on staff," she said. "It is such a shame. They just don't feel valued."

Tomorrow: a midwife, a GP and a health columnist speak out

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