SIXTY YEARS OF THE NATIONAL HEALTH SERVICE Supplement editor Emma Dent RICHARD VIZE Art editor Judy Skidmore Production editor Jane Walsh EDITOR Sub editors Jessica Moss, Amit Srivastava Picture editor Frances Topp Six decades that have transformed the NHS HSJ is delighted to bring you this celebration ‘Managers have of the extraordinary journey the NHS and its metamorphosed from clerks staff have taken since the service was launched six decades ago on 5 July, 1948. into strategic leaders; It charts the currents that have shaped the clinicians have moved from modern NHS, from management, politics, hierarchies into teams and clinical practice, campaigns and public expectations to architecture, the media and the focus on healing is giving popular culture. ground to prevention’ Reminiscences of those who were in post on the first day vie for your attention with stories from three managers who were born in those first hours, and frank recollections from former secretaries of state. We discuss five days that shook the NHS, and see what the service has to learn from the only two institutions on earth with more staff: Indian Railways and the People’s Liberation Army of China. We also reveal the 60 people identified by our panel of judges who have had the greatest influence on the NHS. The stories and analysis reveal a service that has been transformed. Managers have metamorphosed from clerks into strategic leaders; clinicians have moved from rigid hierarchies into multidisciplinary teams; mental health has moved from the asylum to the community; the focus on healing the sick In partnership with is giving ground to prevention. The area that has changed least is the power accorded to the patient. But progress is finally being made; perhaps by the time the NHS marks its 75th anniversary it will be able to celebrate the arrival of a truly patient-centred health service. I am delighted to thank our partners in these NHS 60th celebrations – BT, Tribal, Lloydspharmacy, Humana and Airwave – for their support, which has made this publication possible. We hope you agree it is a fitting tribute to 60 extraordinary years. 3 July 2008 HSJ NHS60 anniversary supplement 1 leader NHS60-jmJW/JW.indd 3 24/6/08 19:41:43 In 1948 the UK population was 50.065 million. Life expectancy was 65.9 for men and 70.3 for women. Many children were affected by rickets (below right), and heart disease and cancer were the most common causes of death. An advertising poster urged ex- nurses to join the National Hospital Service Reserve, and child welfare became a priority (below left). LIFELIFE IINN 11948948 The average house price was £1,751, but thousands of families were living in prefabricated homes after one million houses were destroyed in bombing raids during the war. CORBIS, TOPFOTO, PA, GETTY PA, TOPFOTO, CORBIS, 2 HSJ NHS60 anniversary supplementsupplement 3 JulyJuly 20082008 hsj.co.uk While a male teacher could expect to earn £615 a year, a male manufacturing worker aged over 21 earned on average the equivalent of £6.86 a week; for a female manufacturing worker aged over 18, the figure was just £3.70p a week on average. The Attlee government nationalised the coal industry in 1948 (below left) and the first babies to be born in the NHS arrived that year. On 22 June, the Empire Windrush docked at Tilbury with 492 immigrants from Jamaica, of whom 192 made the voyage on the decks as the cabins were full. BBreadread rrationing,ationing, LIFELIFE IINN which11948 had begun in 948 1946, came to an end in July 1948. Jam was no longer rationed from December. Clothes had been de-rationed from March. A pint of milk cost the equivalent of 2p, a dozen eggs 9p, a pint of beer 7p, a litre of petrol 3p and a The “new look”, cinema ticket 7.5p. introduced by Paris fashion house Dior the previous year, was in vogue in 1948 (left) and the Olympic flame arrived at Wembley for the 14th modern Olympiad (above). hsj.co.uk 3 July 2008 HSJ NHS60 anniversary supplementsupplement 3 FIVE DAYS THAT SHOOK THE NHS community. “The trouble was, The NHS has weathered countless scandals, speeches, policy nobody had asked the community if launches and inquiries. Peter Davies and Daloni Carlisle they did care,” he says. “They didn’t give a damn.” discuss five landmark events and talk to those involved History shows the angels won the battle. “Hospitals began to close incredibly rapidly,” says Dr Rollin, 1961: ENOCH POWELL’S them, with services to be replaced psychiatrist at Horton Hospital in who retired from the NHS in 1975. WATER TOWER SPEECH by care in the community. What Surrey, was among them. “I sided By 1969, 24,000 beds had gone. In March 1961 then health minister psychiatric beds there were would not with the angels,” he says of his “The situation when I retired was Enoch Powell made what became be relocated in general hospitals. decision to fight the bed closures. heartbreaking. All the work we had known as his “water tower” speech The move to close old psychiatric He did not recognise the picture done was destroyed. The to the annual conference of the institutions was already underway, Mr Powell painted of the horrors of community services were not there National Association for Mental he told his audience. “There is not a the institutions, described in the and the patients have simply ended Health, later known as Mind. Mr person present whose ambition is 1962 Hospital Plan as “majestic, up in prison. It is very, very sad.” Powell, of course, is now better not to speed up those present brooding structures, dominated by Dr Rollin’s view is not popular remembered for a rather different trends. So if we are to have the the twin ideas of isolation and today. “Of course closing the speech. But his description of courage of our ambitions, we ought custodialism, housed in depressing institutions was the right thing to asylums as “isolated, majestic, to pitch the estimate lower still, as and decaying buildings, suffering do,” says chief executive of the imperious, brooded over by the low as we dare, perhaps lower.” from acute staff shortages”. Mental Health Foundation Andrew giant water tower and chimney How wrong he was. A gladiatorial Nor did he recognise the running McCulloch. “It was the clear result combined” heralded a shift in battle ensued, fought largely in the down of status of the hospital; he of evidence-based medicine and mental health policy. pages of medical journals the BMJ saw bed numbers at Horton rising. evidence-based health policy.” Mr Powell envisaged the closure and The Lancet, as doctors slugged Dr Rollin was sceptical about He points out that Mr Powell’s of at least half of Britain’s out the rights and wrongs of the whether local authorities would be speech was preceded by the 1959 psychiatric beds, some 75,000 of policy. Dr Henry Rollin, then a capable of setting up facilities in the Mental Health Act, which he 4 HSJ NHS60 anniversary supplement 3 July 2008 hsj.co.uk 4-7 FIVE DAYS...-asAS/JW.indd 1 24/6/08 15:52:08 FIVE DAYS THAT SHOOK THE NHS describes as “a benchmark piece of 1967: THE PUBLICATION OF Dr Michael Denham, past legislation that put its mark on ‘Enoch Powell SANS EVERYTHING president of the British Geriatric legislation around the world”. In 1967, campaigner Barbara Robb Society, has written about the book “The water tower speech described asylums published Sans Everything: a case to and its impact. Drawing on the was key in that it made the answer. A critical look at the care of work of Professor John Martin, who deinstitutionalisation into policy. as “isolated, elderly, mentally ill people in long- in 1984 delivered a scholarly report My personal belief is [Powell] was majestic, imperious, stay institutions, it sparked major about hospital scandals, he says: expressing his own view.” disquiet over the quality of care. “The committees considered the Care in the community has not brooded over by the Barbara Robb had founded Aid majority of allegations of cruelty been an unqualified success and for the Elderly in Government were unfounded or were based on yes, Mr McCulloch adds, the prisons giant water tower Institutions in 1965, following her unreliable evidence. The complaints have taken up part of the population involvement in the care of patient were considered inaccurate, that used to be in the asylums. and chimney”’ Amy Gibbs at Friern Barnet vague, lacking in substance, “But that’s not a criticism of Hospital in London. Her book was a misinterpretations or over- deinstitutionalisation. Some people passionate cry of distress at the emotional.” are achieving world-class mental undignified suffering of elderly The committees were instead health services. The trouble is, we people in hospitals, along with often impressed by the quality of have a complex, evidence-based discussions about solutions. care. The answer lay in greater approach to care but have not sorted Although the book did not name numbers of better trained nurses, out the whole system. hospitals or patients, after receiving they said. Ms Robb was indignant “If there is a perception that care wide publicity Ms Robb passed on and complained to supervisory body in the community is not working, it details to the health minister, who the Council of Tribunals, which is because we have not grasped the instigated “enquiries by special rebuked the minister. bigger picture. Mental health committees” into several But that was not the end of the services get tarred with the brush of institutions.