A reinvigorated NHS — back to the future?

1952 on the death of her father, King George VI, the National Health Service (NHS) was in its infancy. Its initial success in improving and democratising healthcare has been largely forgotten in recent years as a more informed, sophisticated and demanding public have been increasingly strident in their criticism of what is often regarded as a crumbling monument to old-fashioned socialism. The majority have little or no experience of the inequalities of medical care before 1948 when tuberculosis and rheumatic heart disease were common and the infantile paralysis of poliomyelitis the worry of every parent. As a resident in the Royal Infirmary of Edinburgh in 1969 it was an unusual waiting day if peptic ulcer disease did not present with a major haematemesis or with the rigid abdomen of perforation. Thought at the time to be largely stress-induced, duodenal ulcer resulted in much morbidity, the imposition of diets of milk products and steamed fish, and many lost working days. Patients ‘earned’ their operations, such as vagotomy and drainage, by being miserable for about ten years. Who would believe that ulcer healing now takes place within days of starting proton-pump inhibitors and the appropriate antibiotic directed against the causative organism, Helicobacter pylori? At the same time I was impressed by the folklore among patients that it was unusual to survive the third episode of myocardial insufficiency. Now as a result of changes in lifestyle, beta blockers, aspirin, statins, thrombolysis, angioplasty, stenting, and bypass surgery, a diagnosis of coronary artery disease provokes much less anxiety among patients and doctors. And then there are artificial joints, pacemakers, implantable defibrillators, sophisticated methods of imaging, in vitro fertilisation, effective chemotherapies for cancer; and in the EDITORIAL