IN part two of our health check on the NHS at 70, York GP Dr Andy Field, The Press's health columnist Dr Zak Uddin and former midwife turned fertility coach Anne Gledhill give their views on the condition of the health service today

Dr Andrew Field of the York Medical Group

Is the NHS in good health as it reaches 70?

Not especially. It needs nourishment and joining up again after years of under funding and fragmentation resulting from crazy changes, political football playing and flawed attempts to marketise it. There are many good things but morale is as low as I've ever known it and I worry that fewer and fewer people are wanting to work in the NHS.

What works well about it?

The staff still really care, try their hardest and mostly deliver excellent care in difficult circumstances. We enjoy very high levels of service from very well trained staff in pretty well monitored services.

What are the problems?

For years we've pushed staff to do more and more without adequate staffing levels, particularly out of the hospitals. We haven't focused on prevention nearly enough and we have allowed the service to break into parts which don't connect well with each other, don't communicate and don't work as a single system. This is massively wasteful and inefficient. We're also suffering from a big demise and under funding of the social care system.

Is it financially sustainable as we live longer and place more demands upon it?

No. We need to learn how to make more rational rationing decisions and focus our activity better where and when it's needed. We sometimes end up locked into doing expensive things that aren't in the patient's best interest and this has to stop.

What would be your prescription to ensure the NHS can survive for another 70 years?

Somehow we have to rejoin the service into a functional whole, at least the health-related parts but ideally social care too. We have to have a much more mature understanding of what's important to people in terms of prevention of disease, how they want to be treated and what is appropriate for the NHS to deliver. People need to be supported in being more resilient, healthier and self sufficient where possible. We need to reserve our most expensive and highest trained and hardest pushed staff for situations where they're really needed and find other ways of dealing with the huge demand where they're generally not needed.

Anne Gledhill, acupuncturist and fertility coach at, former midwife and NHS manager.

Is the NHS in good health as it reaches 70?

The NHS is not in good health. It is insufficiently resourced for the 21st century and this means that some people do not receive the care they require. The post code lottery is a reality.

According to the National Audit Office, clinical negligence claims cost the NHS £1.6 billion in 2016/17 and the legal costs for these claims was £487 million.

What works well?

Free at the point of use, the NHS has a dedicated and expert workforce providing round-the-clock care. Patients can see a GP in a local surgery, receive a referral to a specialist for treatment and a prescription if necessary. The National Institute for Health and Care Excellence (NICE) has over the last 20 years developed clinical guidelines that draw together the available evidence for a range of medical conditions and recommend a care pathway to be followed ensuring the same standards of care are received across the country.

What are the problems?

Frontline staff report being unable to deliver the quality of care they want to due to insufficient resources. The cost and culture of litigation is decimating the NHS. Clinical practice can be stifled by adherence to NICE and NHS Trust guidelines as one size does not fit all. Clinicians are practicing defensively, fearful that exercising clinical judgement may result in an investigation and/ referral to their regulator.

Is it financially sustainable as we live longer and place more demands upon it?


What would your prescription be to ensure the NHS can survive for another 70 years?

Invest in support for NHS staff. Take into consideration that staff need flexibility in working patterns at different phases of their lives. Term time regular hour contracts will retain skilled staff in the workforce while they have young children. Similarly, people with caring responsibilities also need to be able to balance work and home life.

Investigate alternative models to deliver GP, dental, pharmacy and optometry services. Would services provided directly by the NHS be more cost effective than the current independent contractor model?

Look to the New Zealand model of maternity care provision so that midwives have greater choice in the way they work and women can choose their midwife as a lead maternity carer. Evidence shows that continuity of carer in pregnancy delivers significantly better outcomes.

Implement a system of no fault compensation to provide funds to people who should be compensated and reduce the significant sums paid to lawyers which depletes NHS funds.

Reinstate the ‘Special Class Status’ allowing earlier retirement for clinical staff in recognition of the arduous nature of the duties undertaken.

Dr Zak Uddin, GP and weekly columnist in The Press

The NHS is perhaps the greatest success of the last 70 years, as much of an institution as the Monarchy itself and indeed one which has moved with the times to cope with the challenges it faces.

Revered worldwide, it still adheres to the adage of care “from cradle to grave” and is among a select few healthcare models where priority is based on clinical need as opposed to any other marker. UK-educated doctors and nurses undergo rigorous training and as a result are sought worldwide for their unique blend of knowledge, understanding and compassion.

However, this does not mean a system without problems. The NHS has almost become a victim of its success, and such excellence of care means people are living longer, with more complex health needs. Our lifestyles have changed greatly since 1948 and the twin evils of a more sedentary existence and the rise of convenience food have seen the numbers of individuals with obesity, diabetes and heart disease soar.

Financial stability and even viability threatens the NHS, and news of an NHS Hospital Trust in the red has become an almost weekly occurrence. This may be down to some bad decisions, but we have to be honest: healthcare is an expensive business. An ITU bed costs £1,000 a night, complex operations are costly, and maintaining people on drugs for the rest of their lives all adds up.

However, I wouldn’t for a minute suggest that we disband the NHS or everyone be made to pay for every treatment, irrespective of their financial wellbeing. Yet we are stronger united than as separate individuals and need to acknowledge that the NHS can at best provide for what we need, rather than what we want.

The cost of wasted prescriptions is £300 million a year, with £110 million returned to pharmacies. You could do your part to safeguard the NHS by only ordering medicines you need and avoid stockpiling. Where possible, we need to take care of our own wellbeing, and reap what we sow, so that lives are long and healthy. The future of the NHS is dependent on those who use it as much as those who organise and man this excellent system.

Ellen Willey, 'health service hero' in the 2005 Community Pride Awards and former sister-in-charge of York's Special Care Baby Unit

Ellen Willey came to York from her native Durham as a young woman in the 1950s, to finish her training as a midwife. She ended up staying more than 60 years.

She spent 25 of those years at the old Fulford Maternity Hospital, before becoming sister-in-charge of the Special Care Baby Unit at the new York District Hospital. In 1984, she founded the Special Care Baby Unit Support Group.

Mrs Willey was named Health Service Hero in the York Community Pride Awards in 2005 for her lifetime of dedication to the NHS.

She is 86 now, and has moved to West Yorkshire. But she remains eternally grateful to the NHS for everything it has done for her and her family.

"I have had so much help from the NHS, with my husband and for myself," she said. "I have had a hip replacement, two knees, a cataract operation, you name it. For all the bad press about the health service, all I can say is 'thank you'."

Mrs Willey was just 16 when the NHS was founded. She remembers it well. A niece of hers was born that year and, like countess others, has benefited hugely from the health service ever since.

She agrees that the NHS has changed since its early years - in some ways for the better, in some ways for the worse. "But thank God we have got the health service," she says. "We must make sure it stays in good health."


There was a strong reaction online to our piece about the NHS at 70 in yesterday's newspaper. Here's what some people had to say:

Whitstable Doris: "Is the failure due to too many chiefs and not enough Indians? Bed blocking because of lack of social care, patients not being able to leave because of cutbacks in social services so end up bed blocking? And the NHS should be able to pick cheaper suppliers of items needed. But saying this the staff at York Hospital even through these hard times keep going. Fantastic staff making the best of a bad situation."

Jam222: "Why don't we have ID cards so people who are not entitled to free care have to have medical insurance like in America and most other countries?"

Vegetius: "An American-style health insurance system is great, if you can afford insurance, which most of us won't be able to, or (until) your insurer decides to stop paying out and you're basically left to die."

Olderandwiserbutnotalwaysright: "Most of us would pay more tax IF we thought it would go to the front end. But as many who work for government organisations know, the waste of money is scandalous and there is too much restriction on how and where you can spend it."