BRINGING free health care to the UK was by no means an easy feat – doctors and politicians were divided, the logistics were difficult and many wondered whether it would happen at all.
But few would now doubt the wisdom of the creation of the Natio
nal Health Service. Imagine a return to a system where only the better-off could pay for treatment. Imagine hospitals being run on charitable donations. And imagine a time when a child could die from an easily preventable disease.
As the NHS celebrates its 60th anniversary today, medical staff, politicians and the public rightly hail its many achievements.
But some argue that the next 60 years will see stormy times for the health service, its staff and the patients.
Back in the 1940s, it was Labour health minister Nye Bevan who championed the idea of a health service financed entirely through taxation, nationalising hospitals and health centres to create universal access.
As the nation struggled to get back on its feet after the war, reform of the health system was his major priority, and one he fought for with a vigour rarely seen in today's politicians.
Only those in employment could access free treatment, meaning many women and children were left without care, relying on the charity of doctors and nurses working for free.
John Dow, from Dumbarton, was working as a health clerk both before and after the birth of the NHS.
He remembers how when parents were faced with a child with measles, most would try to avoid the half a crown cost of calling for the doctor.
"That's where the old women came in handy in the tenement blocks. They were a substitute doctor," Mr Dow said.
"The young women would wonder what was wrong with their baby when it had, for example, spots and the old women would come over and tell them if it was measles and what to do."
Sir John Crofton, a Scotland-based pioneer in the treatment of TB, once spoke of a patient from Craigmillar, Edinburgh, in the 1930s whose young daughter fell seriously ill.
"He was far too poor to be able to call in a doctor or even to pay for a journey by bus," Sir John recalled.
"The only thing he could do was take his daughter in his arms and walk the five or six miles up to the Royal Infirmary. When he arrived there he found his daughter was dead."
Given such stories it may surprise some that most doctors were opposed to the NHS when the idea was first proposed.
Bevan was forced into an exhausting series of negotiations with GPs and consultants, with doctors at one point threatening to strike, such was their opposition to the NHS.
They feared political interference in their work, but also the thought of losing their private- practice income.
Eventually Bevan agreed that GPs would keep the freedom to run their practices as small businesses, similar to the situation we have today.
Consultants received a pay boost, as well as being allowed to continue with their private practice.
Asked how he had tackled the impasse, Bevan simply said he had "stuffed their mouths with gold".
In many ways it was Scotland that provided the first model for the NHS. In 1913 the state-funded Highlands and Islands Medical Service was established to care for those in the most remote areas where few doctors wanted to work.
It is also worth remembering that even before the arrival of the NHS, many patients were getting free treatment across Scotland and the UK due to the generosity of charity and doctors and nurses very often working for little reward.
Many doctors would base their charges on a patient's ability to pay rather than see them go without. So once the NHS started work, most came to welcome the benefits of a regular wage.
But it was a wage they had to work for. As was to be expected, the promise of free treatment brought patients forward in their masses.
Within four months of its launch, half a million Scots – a tenth of the entire population – were able to have free spectacles. Half a million also received free dentures in the first year.
Alex Adam, a young doctor working in Inverness when the NHS was born, remembers vividly the hordes of patients that doctors were suddenly faced with. "When the health service started there was huge demand. Everything was to be free," he said.
Mr Adam – who went on to become an orthopaedic surgeon, pioneering hip replacements in Scotland – described the scene faced by one doctor who turned up to a clinic in Peterhead at a time when corsets were often used to treat backache.
"The ladies in Peterhead, always wanting to save a penny, realised that here they had a way of getting free corsets.
"So when the doctor went to this clinic he was dismayed to find the hall full of overweight, Peterhead wifies – hundreds of them, it seemed to him.
"He got up on the platform and said, 'All those who are here for corsets please stand up'. About 90 per cent of the assembled company stood up. 'Well,' he said, 'you can all go home'. So they obediently went home."
But in the years following its inception, the NHS found itself dealing with a lot more than bad backs. Illnesses such as tuberculosis and polio, and a high rate of infant mortality kept staff busy for many years.
Effective treatments for TB and mass screening programmes in the 1950s now mean deaths are rare, while polio deaths have been reduced to zero.
Infant mortality in Scotland has also dropped from 44.7 in every thousand in 1948 to 5.3 in every thousand today.
But Scotland has also led the way in developing many of the advances the NHS now takes for granted.
In the 1950s, scientists in Edinburgh, led by Sir John Crofton, developed a cure for TB using a combination of three antibiotics.
Around the same time scientists in Glasgow were developing early ultrasound technology, now widely used in pregnancy and for diagnosing a range of serious illnesses.
And in 1960, the first kidney transplant was performed in Edinburgh.
Scotland continues to be at the forefront of medical research and searching for the treatments of the future.
But while all four countries of the UK remain true to the founding principles of the NHS, devolution means the delivery of health differs substantially.
Our English neighbours have looked on enviously as Scotland introduced free personal care for the elderly and will soon abolish prescription charges.
The two nations have also taken a different stance on how much they invite the private sector to provide services for the NHS. While Scotland continues to shun private companies getting a hold on the NHS, England has seen a steady growth in GP surgeries and treatment centres run by the independent sector.
Dr Peter Terry, chairman of the British Medical Association Scotland, said: "The best thing about the NHS in Scotland is that it is has kept to its founding principles, where the health service is publicly funded and available to those who need it."
But as the NHS looks to the next 60 years it faces difficult decisions about what it can afford, with ever costlier treatments and an ageing population.
Will we have to accept that a golden age of free treatment for all has been and gone? Whether the NHS as it is today will live to see 120 candles on its cake is by no means a done deal.
THE EXPERT'S INSIGHT
Money is key to our future healthcare
John Smyth, Professor of Medical Oncology, Edinburgh YOU cannot stop scientific progress as the NHS looks to the next 60 years. In that time, we will learn more and more about the way the human body copes with its genetic starting point and the environment we expose our bodies to.
We will get better and better at managing ill-health and screening to know the people at risk from various illnesses.
When you are born, you have a heel-prick blood test to check for cystic fibrosis. But in the future there will be a stage when you are born – or even before you are born – when you will get your genetics done.
This could then show that you have a high risk of conditions such as diabetes or glaucoma, and so on. You will then get preventative medicines or be monitored by doctors.
We will also get better at propping up failing hearts, managing cancer, dealing with obesity and diabetes.
As a result, the average age of the population will nudge up. The development of new technology will require resources and the real challenge is how are we going to pay for healthcare?
We have to educate the public about what can be done to look after your health.
It's no good just saying "I pay my taxes so I've got the NHS". Those days are over.
With scientific advances, society needs to decide how much money it wants to contribute to healthcare.
THE INSIDER'S VIEW
Consultants' mouths 'stuffed with gold'
Alex Adam, Medic working in Inverness on 5 July, 1948WHEN the health service came in, I was made a senior house officer.
The British Medical Association and the medical profession generally were opposed to the health service.
I was at a meeting in 1946 in Aberdeen where strong opposition was expressed by the medical profession.
They wanted to maintain their independence. They were worried that politicians would tell them what to do.
And indeed they did, and have done ever since. It is getting worse and worse.
But Nye Bevan turned the medical profession around. He said he had stuffed their mouths with gold, which of course he did, because he allowed them to do part-time private practice. This was not so much a concern in Scotland, but in England and particularly the south-east it was a concern.
When I went to London in 1954 to finish my training, I went to a hospital as a senior registrar. I was attached to three different consultants.
I had just arrived there and I was sitting in the afternoon doing my consultant outpatient clinic. My consultant came in and said: "Adam, I want to speak to you. You are my registrar and you will do my work. Do not try to phone me out of hours or at weekends. You won't be able to get me." So I did his work, and he did his private practice.
He was immensely wealthy. Their mouths really were stuffed with gold.
The health service came in and they didn't change.
IN QUOTES "I stuffed their mouths with gold"
– Nye Bevan, Labour health minister in 1948
"There was a slight background attitude, particularly among consultants and senior medical staff, that the 'sick poor' were a slightly different species"
– Sir John Crofton, TB treatment pioneer
"I remember telling someone in London that I was working with a professor of medicine, thinking this would boost my ego. But I was told that in London academic status did not matter. It was private practice that counted"
– John Forfar, in 1948 a new consultant in Edinburgh
"Those of us who grieve most must confess we could not carry on very much longer as a purely voluntary institution"
– John Little, chairman of the Edinburgh Royal Infirmary board, at a thanksgiving service, 4 July 1948
"5 July, 1948 was the second of Britain's finest hours in the brave and high-minded 1940s. Like the Battle of Britain it was a statement of intent, a symbol of hope in a formidable, self-confident nation"
– Peter Hennessy, Never Again: Britain 1945-1951
"It was the first health system in any western society to offer free medical care to the entire population"
– Rudolf Klein, The New Politics of the NHS, 2006
"Scotland truly is a nation of innovators, and the NHS is a particularly rich source of good ideas"
– Dr Sandy Allan, Chief Executive Officer, Scottish Health Innovations Ltd
"Devolution has brought different approaches to the NHS in the four nations that make up the United Kingdom and this is resulting in an unquestionable divergence between our health systems"
– Nicola Sturgeon, Scottish health secretary
"The greatest wealth is health"
– Virgil
KEYWORDSTUBERCULOSIS
A disease affecting the lungs and other body parts, caused by the germ tubercle bacillus or mycobacterium tuberculosis. Until effective drugs were introduced about 50 years ago, TB was a major cause of death.
NATIONAL HEALTH SERVICE
The UK's publicly-funded healthcare system, with treatment free at the point of need and regardless of ability to pay.
CONSULTANT
A senior hospital doctor. Along with others, consultants opposed the NHS as they feared being under the control of politicians.
ANEURIN (NYE) BEVAN
Labour health minister and founding father of the National Health Service.
The first baby born on the NHS was lucky enough to find herself given the name Aneira to honour Bevan's achievement.
The full article contains 2201 words and appears in The Scotsman newspaper.
