NHS structure in disarray largely thanks to the way it was founded

OUR NHS, which opened for business on July 5, 1948 as the first system of medical provision, free at the point of need, in any Western democracy, appears now to be forever in the headlines, mostly of a critical nature. One is tempted to wonder what Labour minister Aneurin Bevan, who drove through Parliament the legislation providing for the establishment of the NHS, would make of the situation today.

There are those who will say that with an institution of such a size, however it may be financed and whoever provides the funds, a measure of disorder is inevitable and those who will contend that, with an increasing and ageing population, linked with limited resources, health care for all with no charge is unsustainable.

However, I believe one of the major causes of the state we are in could well be the nature of the arrangements that Bevan concluded with the medical profession in 1948. At the time he had a lengthy and difficult battle with the doctors. Eventually, he permitted hospital doctors to continue with private practice with the result that a large number of the consultants were not available to the health service on a full-time basis. The general practitioners of the day also protested at the plans. Bevan dropped efforts at making the GPs state employees, and agreed they should be treated as small business people with NHS contracts. Bevan subsequently conceded that to get the medical profession on board he had “stuffed their mouths with gold”.

It is not unreasonable to conjecture that some of today’s problems would at least have been moderated if the form of the 1948 deal if the medical profession had been different. Ian W Thomson, 38 Kirkintiloch Road, Lenzie. IS IT not time politicians and the media stopped obsessing about the four-hour waiting time in A&E departments? I think this arbitrary target should be abolished altogether, because it produces a meaningless and misleading set of statistics that cast an unfair slur on a dedicated and hard-working section of the medical and nursing professions.

It is stating the obvious to point out that A&E departments have no control over how many patients may turn up in any given period each day, but each one must be recorded, triaged and given the appropriate medical treatment, no matter how much time that may require. It is pointless to set a completely arbitrary time limit within which that much be achieved, regardless of how many patients are ahead in the queue.

When someone is judged to need more specialised medical attention or hospital treatment that cannot be provided in A&E, that patient must be transferred to the appropriate department or ward.

If that ward does not have a bed immediately available, it is inevitable the patient will have to wait, probably on a trolley, but that is not the fault of A&E and should not be included in that department’s treatment time for statistical purposes.

Bed-blocking is a chronic problem in most hospitals today, in some cases because the number of wards or beds have been reduced to achieve savings, but more often because of delay in discharging patients into social care. That is primarily the responsibility of local authorities, not the NHS and certainly not A & E departments.

And finally, how many pen-pushers, bean-counters and managers are required to produce all the detailed daily and weekly statistics, just to provide ammunition for opposition parties to unfairly criticise government ministers? What savings could be achieved if that small army of clerical staff was got rid of, and the funds used instead to pay for additional doctors, nurses and facilities for A & E and other hospital departments? Iain AD Mann, 7 Kelvin Court, Glasgow. “I HAVE a dream,” said Martin Luther King and so have I: that the NHS could be taken out of the political arena and discussed in a constructive manner by all parties without the points-scoring. Alan Stephen, 15 Beechlands Avenue, Glasgow.