A consultant looks at the NHS todayPart 2 of a text based on a lecture delivered by the author at The Royal London Hospital, England, UK

Abstract

Distinguished colleagues, Ladies and Gentlemen, fifty years ago decisions were made by clinicians and not academics, managers nor politicians and, for the first few years of the NHS, it was run efficiently and at low cost. Patients were only too well aware that the service that they were receiving was excellent and they were grateful. Although the academics, the managers and the politicians have caused medicine to be replaced by a costly, inefficient and incompetent health industry, the blame lies initially at the door of those clinicians who were too concerned with patient care to see the takeover which was occurring. Lord Platt, in his Harveian oration ‘Medical „science: master or servant?’, points out that academic departments had not been responsible for nor even seriously involved in many of the discoveries in therapeutics or preventive medicine (Platt 1967). He goes on to state that ‘the phenomenal success of modern medical treatment seems to have depended almost wholly on non-clinicians, often non-medical scientists, frequently working in, or in close collaboration with, the pharmaceutical industry, and it would be a serious mistake to think that the role of industry has been largely in the field of commercial development. A great deal of the basic scientific work, especially chemical isolation, analysis and synthesis, has taken place there.’ It should be consolation for hard-working „clinicians today to read Platt’s confirmation that ‘ideas come from lucky accidents or from the inspiration of men of imagination’ and ‘a great deal of modern Practice in medicine and surgery has been evolved from men whose researches were part of their daily clinical tasks’. So-called non-academic physicians may find amusing the friend of Lord Platt who talked about some form of research being ‘occupational therapy for the university staff’. A mild comment by myself that the active invasion of the teaching hospitals by the universities had not been an unmixed blessing (Fowler 1985) produced a dismissive response (Booth 1986).