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Well before its 50th anniversary, the National Health Service (NHS) had become inextricably linked with the British way of life, a union with which politicians meddled at their peril. A large part of the population have grown up with the NHS and have known no other pattern of health service provision. Many would, however, be aware of the bad old days of paying for even elementary care or going without and it is doubtful if anyone, medical or lay, would seriously wish to turn the clock back to that era.
Clearly, the improvements in and access to general practice and the hospital services are the areas with which most people are familiar but it has to be acknowledged that a large part of the general health improvement has come from public health measures, better housing, diet, working conditions and so forth. This does not detract from the enormous benefits of newer and more effective drugs, surgery, investigations and nursing care available throughout the NHS which are largely free at the point of use.
For anyone or any corporate body, a 50th anniversary is a major milestone. There is no comparable British organisation which can claim to have retained and built on its original objectives in spite of internal changes and external pressures over the last half century. It is entirely appropriate, though some might say ironic given its earlier opposition, that the British Medical Journal(BMJ) should produce this fascinating volume celebrating the first 50 years of the NHS. This is not simply another potted history of the NHS although there is a section recording many of the key events of the 20th century which have shaped the NHS as we know it. The editor, Gordon Macpherson, a former deputy editor of the BMJ, has brought together a series of linked personal perspectives from individuals who have worked in or been closely associated with the health service. The result is a fascinating, thought-provoking and eminently readable work covering a wide range of issues from 30 distinguished contributors. Many of these are well known and respected and the majority are medical, but a balance is maintained by contributions from politicians, a journalist, a medical student, economists and health service managers. This ensures a sense of reality, with many areas exposed where the NHS could do better, in contrast to the numerous areas where social, political, scientific, economic and organisational changes have far-reaching effects.
A number of newspaper cartoons illustrate some of the stresses in the NHS over the years and photographs of many of the key figures involved in the big issues of the day put faces to half-remembered names. The biggest challenge to the NHS lies in the future. How will it cope with demographic changes involving patients and staff, with new medical, surgical, pharmaceutical or molecular biological techniques, new funding pressures and how will it maintain equity of access and services when public and political expectations will necessitate hard choices? Each contributor has included a succinct section with his or her views of the future direction. All those planning or working and living with the NHS now could do well to take careful note of the collective wisdom in this book to guide the NHS into the new millennium and its centenary celebrations.
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