BACK in June, at a reunion held in Edinburgh, 46 retired doctors gathered to celebrate the 60th anniversary of their graduation from university. "We feel there’s a rather special camaraderie that exists amongst us," says Dr Douglas Bell, who organised the get-together, the eighth since 1969. "It is probably because of the collective privations we experienced, with food and clothes rationing and the total disappearance of everyday things such as bananas!"
Their course was of five years’ duration and some simple mental arithmetic will soon reveal that they embarked on their studies during wartime, completing their degree three years after the war’s end. In many ways they were the lucky ones. Not only did they get a fine qualification, but as Dr Bell points out, those who failed “got a khaki suit for a present”. And if you didn’t go into the services you were likely to become a 'Bevin Boy', named after the wartime minister of labour, Ernest Bevin, whose scheme saw 48,000 18–25-year-olds conscripted into the mines between 1943 and 1948.
But there is another 'special camaraderie' that binds these medics. For on the very day they qualified, 5 July 1948, eager to embark on their chosen career, the medical landscape in Britain was transformed – the National Health Service was launched.
To be fair, the idea of government-run health services was nothing new in Scotland. The Highlands and Islands Medical Service, set up in 1913, was directly funded by the state and administered by the Scottish Office in Edinburgh. But in 1939, only around half of all Scots had a GP, and while hospital treatment was available at most voluntary hospitals, it was as charity and not a right. Hence the extension of services freely to everyone was revolutionary, and the booklet that went out to families outlined the promise of, among other things, a family doctor for everyone, medicines on prescription, dental services, free spectacles and free hospital treatment.
Within the first four months, half a million Scots had free spectacles, and in the first year, half a million got free dentures. The next 60 years coincided with a pharmaceutical and technological explosion, including the ready availability of infection-busting antibiotics, the contraceptive pill, kidney dialysis, ultrasound, chemotherapy, MRI scanners, in vitro fertilisation, keyhole surgery and organ transplants. Thanks to vaccines, polio and diphtheria are now almost unheard of, and the Abortion Act has made backstreet terminations a thing of the past.
There have been challenges, too, such as the advent of Aids and the emergence of the superbugs MRSA and C. difficile. Perhaps the biggest challenge of all, one which has dogged the service from the very beginning, is the question of how to fund this behemoth. Even in the very early years, the cost of the NHS turned out to be 40% higher than predictions.
Charges were introduced for dentures and spectacles as early as 1951 – a move which would lead the Health Secretary who launched the service, Aneurin Bevan, to resign in disgust – and a year later the price of one shilling was attached to prescriptions. Among those at the Edinburgh reunion were two doctors from Australia, two from the USA and four from Canada, reflecting the many graduates who went off to staff so many medical faculties overseas. But the rest of the alumni were the men and women on whom the new service would rely for its success, the young blood that would go on to perfuse the arteries of the NHS for a full career.
In the following, three members of the Class of '48 – Douglas Bell, John Marks and Jake Davidson – offer a view of a life within the health colossus they grew up with and that grew up with them.
Douglas Bell: GP and medical inspector
Not everyone was in favour of Nye Bevan's NHS plan and Douglas Bell says he was one of the doubters. "Having been brought up as a Conservative, I had an instinctive dislike of what Aneurin Bevan was proposing," he explains, although he admits: "I was opposed to the service more because of him than because of what he was proposing."
Nevertheless he was involved in it very early and remembers well the excitement. " did a locum in a mining community in Fife in August 1948. The queue outside my surgery was bigger than the queue outside the cinema up the street. The free consultations, albeit with someone who was qualified a month, were very attractive, quite apart from free prescriptions. And if one remonstrated with patients when calls were judged to be unnecessary, the answer would be, 'But you’re paid for it, doctor.'"
After various jobs, including one as a ship’s surgeon plying the waters between Britain and New Zealand ("I survived most of the passengers and they survived it too"), Bell went into general practice in Edinburgh in 1954. His training had been good, but he feels he may have been one of the lucky ones in what was an informal system. "I had a very good trainer who took his duties very seriously. But I think many other trainee assistants were cheap labour paid for by the state. Now with the RCGP and the standards they set, family doctors are going to continue to improve."
Starting work as a GP, with no access then to diagnostic services, Bell felt immediately frustrated. "We became in effect doctors who either wrote prescriptions or referred patients to hospital. We couldn’t get even a chest X-ray or a blood test without going through the hospital."
With no support staff, he often worked seven days a week and is impressed with the current hours. "I really take my hat off to family doctors who have been able to cultivate contractual terms which allow them to contemplate having no consulting hours after half-five and none at the weekend."
It was the long hours – 20 home visits a day with five hours on two consulting sessions – that eventually drove Bell, "fed up with the NHS", to give up his GP practice. He went to work as a medical inspector in the early 1970s, a new career that took him up to retirement.
As to the future of the NHS, he declares himself optimistic. The service’s great success, he says, is "its ability to cope with emergencies". On the minus side he names the administration costs of an “overmanaged” system and league tables. "League tables of hospital efficiency and tables of mortality rate comparing one cardiac surgeon with another are grossly unfair because patients vary and there are so many other variables. Such league tables require careful and intelligent interpretation."
John Marks: GP and former BMA Chairman
John Marks was passionately in favour of the NHS from its inception, though for someone who would come to head the BMA, he admits his grasp of the detail was minimal. "We weren’t worried about what was proposed, we were worried about getting qualified," he jokes.
But he does remember the initial demand among patients. "It was unbelievable. So many people had needed surgery and hadn’t been able to think about it. People with huge hernias, women with enormous prolapses," he says. "Then there was the false demand, people asking for free wigs – for a while they got them then the government stopped it."
After a stint in the Royal Army Medical Corps, Marks returned to the UK and entered general practice in time to see prescription charges brought in. He remembers: "There was great anger about it. And about dental charges as well. The NHS was only four years old! We worked that last day until about midnight. People were coming in to save a shilling."
But it was medical politics that really exercised Marks and he became increasingly involved, though continuing to practise as a GP. When the BMA opposed David Steel’s Abortion Act he fought hard to overturn their view. "It incensed me. The attitude of the BMA hierarchy was that although it was legal it was unethical. Unbelievable! It was sheer prejudice. They thought the only people who would need an abortion were 'unmarried sluts'."
He won that battle and says that within three years there was a volte-face within the GP community. "They’d seen the benefit of it: women didn’t die, they didn’t become sterile and they didn’t become infected."
The most high-profile political skirmish of all, however, was over the Tories' plans to introduce an internal market into the NHS in the late 1980s. Under his leadership the BMA wanted to see the scheme piloted first. "Ken Clarke [the then Health Secretary] said, 'You buggers would sabotage it.' He was obsessed with hatred of the BMA. He said we were the worst trade union he’d ever dealt with." Marks’s formidable ad campaign against the plans included slogans like, "What do you call a man who ignores medical advice? Kenneth Clarke."
Despite winning the propaganda war, the reforms went ahead untested. It was the beginning of a black period, Marks believes, and he says the NHS’s future is "miserable". He reserves his greatest criticism for the current Labour government, however. "Blair said, 'We’ll get rid of the internal market.' And they did for about two years and then they brought it in. At a recent march, I said to my mates 'Aneuran Bevin is turning in his grave'. The Tories would never have got away with it."
John Davidson: radiologist
"I got the impression it was a good idea, because people had difficulty paying doctors’ bills," says John ('Jake') Davidson, explaining his initial approval of the NHS scheme. But he also remembers a considerable amount of opposition to the setting up of the service, particularly among those who were established with large private practices. "I was in Edinburgh to begin with and there were several senior chiefs in the Royal Infirmary and elsewhere in Leith who were really quite against the NHS."
Following GP training in Edinburgh, Davidson worked as an assistant in Leith, but after what he describes as a "lousy offer" of a partnership, which included doing all the night calls, he was advised to try his hand in the expanding field of radiology. As he recalls, "A friend in the Union Bar said, 'Jake you’ll do very well, most of the radiologists are dropouts. You’re just barely above them.' "
It was, in fact, a very exciting time for radiologists. Ultrasound was being developed in Glasgow and other technological advances were around the corner. Angiography, CT and later MRI scanners, nuclear medicine and interventional techniques and other ongoing developments kept things interesting for decades to come. "We were learning new techniques at the age of 60 to 65 when a lot of surgeons were bored to tears with what they were doing. It was just the way it worked out; I could never have envisaged it."
Having been appointed consultant in administrative charge at Glasgow's Western Infirmary in 1967, Davidson was to become familiar with the financial pressures on the NHS. There were fierce battles over money for equipment. "There was a lot of opposition to it, but the opposition came not just from the health board but also from other doctors. There was only a limited amount of money to go round and a CAT scanner costing a million pounds was a huge bite out of the general budget. But things began to change and people began to realise that radiology was a frontline specialty."
Davidson remains a firm believer in the NHS and is optimistic about the future. "When I was working and we were desperate for money, I thought the whole thing was a disaster, but I don’t think that now. I am at the receiving end and I think it works very well, bearing in mind it’s a huge organisation. I don’t know the answer to that but as long as the government pays for it, they have to keep some control over the spending." Of his time in the service, he is unequivocal.
"Looking back on it all, I enjoyed it. People will be astonished to hear me say that."
Adam Campbell is a freelance writer and regular contributor to Summons. He lives in Edinburgh