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The idealised NHS, created in 1948 by Health Secretary and Welsh political hero Aneurin Bevan, meant free healthcare for all, with no-one having to suffer because they couldn't afford medical treatment. But shortly after celebrating its fiftieth birthday the modern NHS is again in crisis - essentially because of limited resources and increasing demand, but specifically because of a winter flu outbreak which may be no worse than usual. At one stage there were only 15 empty intensive care beds available in the whole of England.
But who's to blame for the current situation?
Well it seems there would be many possible culprits --- including the users of the NHS.
We're told that Britain is a nation of wimps who phone for an ambulance just because they have a runny nose.
And it does seem that people choose to queue in the packed Accident and Emergency room of their nearest hospital rather than going to see their family doctor.
Some writers in the UK press have suggested that people believe that illness has no place in their lives and so they shouldn't have to make time for it therefore going straight to the hospital. It could be that the NHS is a victim of its own success - free health care means we're all living longer, and new developments in medicine and technology means that some of us are living far longer than we would have been in our grandparents' times.
To tackle the problem of resources and demand, the previous Conservative government decided to run the NHS as a business, turning patients into consumers and pitting competing departments against each other as ministers tried to bring about efficiencies in health care through the discipline of market forces. The problem with treating patients like consumers is that they found service and they want it now. So no more waiting at the doctorsâ surgery to see their GP - instead theyâre straight off down the hospital.
The NHS is also chronically short of nurses with eight thousand vacant posts, although many would argue even if they were filled, many more nurses would be needed to serve the nation's needs.
The number of qualified nurses has decreased for a number of reasons - the most important one being the poor rate of pay for them within the NHS. Nursing salaries start at around £13,000 ($21,000) rising to around £17,000 ($28,000) for senior staff nurses. Although you can double your money by moving into hospital management positions, nursing jobs are relatively poorly paid - especially when you consider the pressure and frequently long hours worked.
Even when extra money has been made available for hospitals to take on more nursing staff there haven't been many takers.
In fact the staffing situation is so bad that the NHS has been hiring nurses from countries like the Philippines where NHS wages actually look generous. Another contributing factor has been the amount of places on nursing training courses that has occurred in previous years. Labour have just announced that it plans to create another six thousand training places over the next three years but it might prove to be too little too late.
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"We recognise the contribution of nurses. We are also working to improve the quality of their working lives. As the current recruitment drive proceeds, let me make it clear that our evidence to the pay review bodies suggests the need for pay reform to make sure that nurses have modern, fair and flexible employment within the Health Service. Specifically, we have called for the review body to take into account the special circumstances of nurses, particularly nurses starting out in the NHS. This government is putting extra resources into the NHS which will make it possible to deliver a better service for patients, hand in hand with a fair deal for nurses."
All very fine words - but in practice all UK governments, whether Labour or Conservative, are very reluctant to grant big pay increases to workers in the public sector as it'll increase the budget deficit and put pressure on ministers to raise taxes. Yet many opinion polls in recent years have shown that the British public are quite prepared to see their taxes increase if it means giving key public sector workers like nurses and teachers a decent pay rise.
One of the main reasons why Labour won the election in May 1997 was their promise to end the growing funding crisis in the health service. One key target has been to cut waiting lists but now that theyâre in power theyâre finding out how difficult it is to solve without doing what seems to be the unthinkable - spending more taxpayersâ money. Britainâs National Health Service has been the envy of the world - but in the end you get what you pay for.
Marie Irshad January 1999
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