NHS (60th Anniversary)

With some exceptions, I have been desperately disappointed with this debate, which instead of being a celebration of 60 years of the health service, has descended into party political bickering. I was hoping, as there was no time limit, to devote a little time to reminiscing. I have been in the health service more than 50 years—much longer than most other people here—so I can remember the days when we had precisely three antibiotics: streptomycin, penicillin and tetracycline. We did not have MRSA because there were so few antibiotics that the bugs could not get used to them. We had aspirin, morphine and digoxin. We had largactil and the barbiturates, but no antidepressants, no tranquillisers, no beta blockers, no ulcer healing drugs, no ACE inhibitors, no statins—and I could go on for a long time. The ““British National Formulary”” in those days was absolutely useless, because there were no drugs to put in it. We did not know how to do endoscopy, ultrasound had not come in, computerised tomography scans had not been introduced, and magnetic resonance imaging was a long way off. Diagnoses were still made the proper way by taking a careful history, making a careful examination and carrying out a few investigations to prove what a doctor was already pretty sure of. We were still in the days of William Osler, who wrote:"““One finger in the throat and one in the rectum makes a good diagnostician””." I do not think that he expected both fingers to be in those places at the same time, because one would have had to be something of a contortionist, but that phrase makes the point that clinical skills were necessary. There is not much time to reminisce, but let us remember what used to happen with heart attacks. All we did when I qualified was to put the patient to bed and hope. Patients were kept in bed for four to six weeks, and if they did not get a pulmonary embolism, the doctor was really lucky. I was working at the London chest hospital when external cardiac massage was discovered. We were staggered by its effectiveness; people were awake when we did it. I was involved with the very first pacemakers used. Since then, the first major cardiac care breakthrough came in the 1980s with the invention of the clot-busting drugs and the ACE—angiotensin converting enzyme—inhibitors, which transformed the treatment. We have come a vast distance with the treatment of heart attacks, with the immediate reboring of the arteries when necessary. We know how to prevent heart attacks, at least by attacking smoking, diet and high blood pressure and by using the statins. Now, the ““British National Formulary”” is the most prized document that any doctor carries with him, because if doctors use it well they cannot really make any mistakes with prescribing. Any celebration has to give credit to the staff, the doctors, the nurses, the secretaries and the volunteers in the charities. Above all, credit must go to the patients, who are so tough, stoical and co-operative with the staff. I worked with patients with rheumatoid arthritis for a long time; it is a most painful, disabling disease. Until very recently it was uncontrollable, yet those patients remained cheerful. Looking briefly to the future, what are the challenges? They have been mentioned—vastly increasing longevity, the incidence of dementia, and vastly increasing costs—and resources are crucial. We must optimise the use of resources. Economies must be made. The Government are to be congratulated on the better care, better value indicators, which at least make a start on making appropriate use of so many resources. We must eliminate the medical errors, along with the immense costs associated with them, and we must get prioritisation correct. I was not allowed to use the word ““rationing”” in a debate not long ago, but health care rationing is crucial, and it demands an open, honest and widespread debate. If there was more money available—not by getting more, but by making better use of what we have—perhaps the National Institute for Health and Clinical Excellence would allow us to afford more drugs. If NICE were able to assess new drugs much more quickly, we might not have the huge problems of co-payments, which have been raised so frequently recently. Reorganisations have been mentioned many times. When the Health Committee undertook an inquiry on foundation trusts, we listed the reorganisations between 1982 and 2003. There were 18 in those 20 years, and the pace of reorganisation has continued. We face perhaps the biggest change and reorganisation of all with Lord Darzi's review. The one comfort is that he has said clearly that no changes are to be made until the replacement service is up and running. I hope that that happens. I am grateful that the Government have reaffirmed the principles of the NHS—that it is funded by general taxation and free at the point of delivery—and that those are immutable, but there is one vital bit of Bevan's work that is missing. Bevan realised that we had to pay doctors and nurses the same across the country to get universality of providers and a real national health service. So a consultant working in London was paid the same as a consultant working out in the country. That achieved a real NHS. My sadness is that with the internal market and the purchaser-provider split, as well as the interests of shareholders in the large commercial organisations tendering for parts of the core NHS, there is a risk of seeing the NHS as we know it disappear. I shall finish by talking about quality of care. I am delighted that the Secretary of State must have read the old proverb,"““A merry heart doeth good like a medicine””," because he is persuading the nurses to smile. There is no doubt that cheerful, kind and sympathetic caring by doctors and others, and doctors and nurses who communicate with each other and with patients, will do away with most of the complaints that I receive. My problem is to know which to vote for: the motion or the amendment. Both have good points. If we have votes on both, I will have the greatest pleasure in voting for both.