National Health Service: A revolution in caring for our health

With the NHS celebrating its 60th anniversary tomorrow, we meet five people who recall its early days and reflect on its impact.

TOMORROW, the National Health Service celebrates its 60th anniversary. Born from the ideal that good health care should be available to all, regardless of wealth, it revolutionised medical care in Britain.

Many changes have taken place since its inception, with huge advances in treatment and technology ensuring we all live longer.

Increased life expectancy brings other problems though, such as dealing with dementia and long-term treatments for cancer and HIV, while richer lifestyles mean poverty-related illnesses have been replaced by obesity and diabetes.

Some of those who lived through the changes told of their experiences.

THE CONSULTANT
Professor John Forfar, former Western General, Leith Hospital and ERI consultant
It was when the US Senior Medical Officer demanded to know just what the young member of the 47th Royal Marine Commando regiment planned to do with his medical career after the war, that the future of John Forfar was set.

"You want to be in paediatrics,' he boomed at me, "smiles Professor Forfar recalling that day in Southampton.

"I had no interest in children's medicine before that. But he was right – there were hardly any paediatricians in the UK then. In fact about 100 in the whole country."

So it was, that after doing his bit for Queen and country – he was involved in the D-Day landings at Normandy – he returned to Scotland and was given a university post in Dundee's training hospital.

He was there when the NHS was launched, although two years later he moved to Edinburgh's Western General – a hospital then managed by the local authority – as a consultant paediatrician, and spent the rest of his career caring for the city's children.

"Initially I had to cover the Western and Leith hospitals," recalls the 91-year-old from his home in Ravelston Heights.

"And I was also on-call for the Kirkcaldy hospital. That meant going to Fife by ferry because there was no road bridge then. The ferry master knew that I was there to care for children so he always put me to the front of the queue," he laughs.

"It is important to remember what healthcare was like before the NHS. When I came to Edinburgh there was just me and the registrar, there were so few involved in paediatrics.

"With the advent of the NHS it meant that doctors could specialise in children because they had a salary.

"Dealing with children before then didn't pay at all well as parents just couldn't afford it. That's why most doctors dealt with adults, and some did a little children's medicine on the side.

"Before the NHS there used to be open clinics on Saturday mornings at hospitals and they'd be overflowing with people who'd waited all week to see a doctor because they couldn't afford to take a day off work or pay for a doctor to come and see them.

"There were children's units all over the place – the Sick Kids, the Western, Bruntsfield, the Deaconess . . . there was always a tremendous resistance to units being closed, but it was inevitable because of costs. At the Western the unit was run by the local authority and the doctors there weren't trained to the same standard really. In fact, local authority doctors didn't become part of the NHS until 1974.

"When I came to Edinburgh in 1950 a new children's hospital was being promised – and it still is!"

TB meningitis was one of the main children's illnesses when the NHS was launched as was polio, and through vaccination programmes have been eradicated.

"Vaccinations are one of the most important things to have happened. The NHS was all about prevention as well as treatment, and never more so than in children's diseases. Whooping cough and diphtheria have also disappeared. I would always tell a parent to get their child vaccinated – especially the MMR. There's no evidence of a link to autism at all as far as I can tell," he says.

"Of course even under the NHS parents weren't allowed to be with their children in the hospital at first.

"They got to visit at weekends only and that was very restricted. It was terrifying for child and parent. I hope over the years we've become much more attuned to the fears of parents, and communicate with them more." By 1964 he had moved to the ERI, and it's thanks to Prof Forfar that the ERI was one of the first hospitals in the UK to have a special care baby unit for premature babies – he, along with nurse Mary Taylor, set it up in 1968.

"It took four years to get it going, and there was some opposition from obstetricians, but we got there," he says.

Of the future, he says: "There are things which have not disappeared though – cerebral palsy, spina bifida, cystic fibrosis, even asthma, eczema and allergies. Genetics are bound to play a huge part in the future of the NHS."

THE NURSING OFFICER
Mary Taylor worked at the City Hospital, ERI and Simpson Memorial Maternity Pavilion
"I started my training in 1957 in Aberdeen, so the NHS had been on the go for nine years by then," says Mary Taylor, now 71 and living in Craiglockhart.

"I was three years in Aberdeen doing sick children training then came to the ERI for my general training, where I helped to nurse the first ever kidney transplant patients. Then I moved to the Simpson Memorial Maternity Pavilion for my midwifery training."

Along with Prof Forfar, Mary would go on to work at the neo-natal forefront in Edinburgh.

"I ended up in a ward sister post in post-natal, but the matron knew I was more interested in the baby side rather than the mother side, so she asked me if I'd be interested in helping set up the special care baby unit.

"I was there for 15 years, before moving into administration and ending up a nursing officer – a job that doesn't exist now!"

She adds: "When I started out things were pretty basic. The nurses were doing a lot of cleaning, soaked the nappies in Dettol, cleaned lockers, and the bedpans. And we didn't have the same infections as they do now.

"As far as equipment went we did have a few incubators – not the sophisticated Perspex things they have now, but metal boxes with a window in their tops so we could see they were OK. They really just kept the baby warm. One of the main things that has changed is the counselling available for parents who lose a child. I think that's a great thing.

"Back then they often didn't even get to see their child if it died, it was just taken away, and stillbirths were hushed up."

Mary recalls how strict the rules and regulations were: "The uniform was a blue/grey dress, a white apron, black stockings and shoes, a cap and a cape. No jewellery was allowed except wedding rings and a fob watch for checking pulses. We took a great pride in our uniform and were never allowed to wear it outside.

"We also had to stay in nurses digs, and a late pass out was until 10pm, which you had to request in advance. Boyfriends had to be very careful. It was a good life, though."

THE GRADUATE
Dr John Marks, a former British Medical Association chairman, was one of 120 medical students who qualified on July 5 1948 – the day the NHS came into existence
"I remember listening to the wireless in the morning when the newsreader said, 'Today is a great day for British medicine'," says Dr John Marks, recalling the day he graduated in medicine from Edinburgh University. "Then, at 6pm, the university authorities put up our exam results on the notice board. I had passed and Rosemary Davey, the genius of the year, looked at me and said, 'I suppose you're going to get drunk?' and I replied, 'too bloody true' – and I did."

Nine days later, the Hackney-born medic went straight into a locum job in Shoreditch, east London at a salary of £250 a year. "The demand when the NHS started was unbelievable. Before the health service started there was guaranteed treatment through National Health Insurance for low-paid workers but even then their families were excluded. There was an enormous demand for surgery for previously untreated conditions. Also, for things like wigs and, in some places, cotton wool because it was free."

Now retired as a GP, his assessment of his time in the NHS is borne of frustration. "It was always starved of money and if we'd had the sort of money then that is being thrown at it now, we'd have had the best health facility in the world bar none," he says. "But it remains the greatest social experiment in history."

THE NURSE
Hilda Willis, 73, of South Gyle, former Liberton Hospital and ERI general nurse, and Royal Edinburgh Hospital psychiatric nurse
Hilda saw many changes to the role of the nurse in almost 30 years with the NHS starting in 1968.

"When I started, a lot of nurses were dedicated to nursing beyond anything else: they never had children, they never married, they were nurses and that was it," she said.

Though she believes that today's nurses are no less dedicated, she believes the nature of the job has changed.

"I know from when I was in hospital that it is very hard to find a nurse in a ward. They knew as much about patients as the other patients did. Our matrons were in charge of all patients on a ward."

She remembers clearly the high standards of hygiene she was responsible for maintaining.

"Nurses had things to clean, just like domestics – everything was clean. If you were changing a dressing you would wash your hands, then you would hold your hands out, open the curtain with your elbow, take the dressing towel off and put it straight in the bin.

"Now nurses just wash their hands in the sink and that's it."

She also laments the demise of ward matrons, a traditional role which is beginning to make a comeback in the 21st century.

"I think it would be better if you put nurses back in charge of hospitals. People are going into hospital and coming out with all kinds of infections. Anything they do doesn't seem to be working."

Some changes, such as nurses getting more autonomy and being graded on their experience, she believes, have undoubtedly been for the better.

One significant change she witnessed was a dramatic rise in number of male nurses. Whilst always common in psychiatric nursing, there were few in general nursing until the 1970s.

"We had to chaperone male nurses," she says. "If we were taking them into the staff room we had to knock on the door and say 'Do you mind if I bring him in?'"

Though she left the NHS in 1995 Mrs Willis continues to work as a nurse in Broxburn for an independent nursing home.

THE PATIENT
Val Turner used to live in Colinton but now stays in Queensland, Australia. She recalls being treated in hospital as a young girl, pre-NHS
"I used to love seeing the nurses and sisters in their white starched uniforms, looking so lovely, cool and sterile. I used to think, 'this is for me', but then, when I was told of the bedpans, slops, and eternal hard work, it somehow wore off.

"I had my tonsils out in the Royal Hospital for Sick Children.

I was scared, away from home and my mother and sisters, and being in this very strange world of whiteness. I remember visiting hours were once a week, on a Wednesday afternoon for one hour.

"Another time in hospital I had pneumonia and spent the entire summer holidays from school out on the balcony, way up on the fifth or sixth floor. I was in a "cot". When it rained they threw a tarp over it."

ACROSS THE YEARS IN THE NHS

1948 NHS launched on July 5.

1952 Charge of one shilling (5p) for prescriptions, and a flat-rate fee of £1 for ordinary dental treatment brought in. Prescription charges were abolished in 1965, but they were reintroduced in 1968.

1954 Daily visits were phased in for children in hospital. Until then, parents could only see them at weekends. Meanwhile, Sir Richard Doll's research into lung cancer established a link with smoking.

1958 Polio and diphtheria vaccinations introduced, and a scheme to vaccinate all under-15s launched.

1960 The UK's first kidney transplant was successfully carried out at the Edinburgh Royal Infirmary by Michael Woodruff, involving a set of 49-year-old twins.

1961 The contraceptive Pill was made widely available.

1967 The Abortion Act was introduced by Liberal MP David Steel. It became law on April 27 1968.

1968 Surgeon Donald Ross carried out Britain's first heart transplant at the National Heart Hospital in Marylebone, London. It took seven hours, and was the tenth heart transplant to be undertaken worldwide since Christiaan Barnard carried out the first successful operation in Cape Town, South Africa, in December 1967. The patient died after 46 days and only six more transplants were carried out over the next ten years.

1972 CT scans introduced.

1978 Louise Brown became the world's first baby to be born as a result of in-vitro fertilisation. She was given the nickname "the test-tube baby".

1980 MRI scans were introduced and the first successful instance of keyhole surgery took place with the removal of a gallbladder.

1981 The 1981 Census showed that 11 babies in every 1000 died before the age of one. In 1900 the figure was 160.

1986 The government launched the biggest public health campaign in history to educate people about the threat of Aids as a result of HIV.

1988 A comprehensive national breast-screening programme was brought in.

1990 The NHS and Community Care Act launched the NHS internal market,meaning health authorities could manage their own budgets and buy in healthcare from hospitals and other health organisations. In order to be deemed a "provider" of such healthcare, organisations took on NHS Trust status.

1994 A national register for organ donation was set up to co-ordinate supply and demand after a five-year campaign.

1996 The first Maggie's Cancer Caring Centre opened at the Western General.

1998 NHS Direct was launched. A nurse-led advice service it continues to provide people with 24-hour health advice over the phone.

2000 Pancreas transplants introduced at the Edinburgh Royal Infirmary.

2001 A two-day-old baby became the youngest in the world to be saved by pioneering keyhole surgery. Surgeons Gordon McKinley and Fraser Munro at Edinburgh's Sick Kids compared the operation on Ebony Martin, who weighed just over 5lb, to "working inside a matchbox".

The 20-acre Edinburgh Royal Infirmary site at Lauriston Place was sold for £30 million to developers Southside Capital Ltd, to be replaced by a £184 million new hospital at Little France.

2004 All patients waiting longer than six months for an operation were given a choice of an alternative place of treatment.

2008 The first live liver transplant was carried out by surgeons Murat Akyol and Ernest Hidalgo at the Edinburgh Royal Infirmary. Jennifer Foster donated over half of her liver to her husband Daniel Foster.