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Reflections on retirement
  1. Philip D Welsby
  1. Correspondence to:
 Dr Philip D Welsby
 1, Burnbrae, Edinburgh EH12 8UB, UK; Philipwelsby{at}

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While the National Health Service continues to provide an outstanding health care system for the UK population, there is a very real decline in NHS morale

I retired from the National Health Service after 26 years as a consultant, having done most of the right things and concealing most of the wrong things. Obviously what follows has to be selective and focuses on my experiences. While I have gained a lot of medical experience, experience is by definition all in the past and, such is the increasing rate of change, experience is sadly becoming increasingly less relevant.

This paragraph was written last to put all the worrying aspects that follow into perspective. The NHS provides an outstanding health care system, free at the point of need, and which functions from cradle to grave. Of course the NHS could and should be improved but the focus on minor problems should not obscure the many major achievements. For example, the media focus on perceived failure of immediate availability of highly expensive new drugs for a minute minority often disregards the support services that we all (including such minorities) have routinely received that enable the need for such drugs to become apparent.


There is a reported decline in NHS morale. I suspect this is real and not a reflection of ageing (my ageing, not that of the NHS). There seem to be five major causes.

Firstly, most NHS workers are attracted to health care for emotional motives, a desire for inner warmth when helping people, which the focus on modern high technology care does not necessarily fulfil. High technology care requires specialisation which inevitably means focusing on parts of people; because technologically minded clinicians are often less “people orientated”, they become disillusioned after decades of coping with human conditions such as obesity, smoking-related …

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  • Conflict of interest: none stated