Half a century of healing

Fifty years ago saw the birth of the National Health Service, the cornerstone of the welfare state. Dr Anthony Twort qualified as a doctor in its first month and struggled to fit in to a system being recast for the post-war age. Dr. Saurabh Jha qualified last year, and is now working as a house officer in a busy hospital. Here, they compare the NHS they know

DR ANTHONY TWORT

joined the nhs in 1948

ANTHONY TWORT was lucky to train at St Thomas's and get his first house job there. "In those days it was dependent on how you did in your exams, but also who your father was and luckily my father was there."

He remembers the beginning of the NHS clearly. "There was a feeling of suspicion about the NHS, particularly in the teaching hospitals. For a young person like me, you were so busy it didn't make a great deal of difference, but I had mixed feelings. Obviously, there was the benefit of government money but there was also the anxiety about lay administration and who was in control. I remember the Christmas show that year where we all sang a song `The Army of Clerks Has Won the Day'."

Dr Twort worked in casualty and once every four weeks they would have what they called "a major week" when surgical and medical emergencies were pushed through. "I remember seeing one chap at the end of one of these major weeks. He was so exhausted. He was near breaking point. We used to yearn for a few bed blockers so that we could get another emergency case in to be dealt with.

"The Resident Assistant Physician and the Resident Assistant Surgeon had the real control. The consultants would do their Harley Street stuff and they varied an awful lot. We used to appreciate consultants who could talk about something outside medicine, who could talk about Shakespeare or philosophy. At that time, it was very much that the patients weren't told anything; there was no sense of the partnership idea in those days. And so there was quite a lot of this Sir Lancelot Spratt business. There was often a lack of sensitivity that was absolutely shocking to the house officers. I remember one paediatrician consultant being irritated by a mother who was only asking him for some information and he turned round and told everyone, including the students `This poor child is suffering from mater-itis'."

He said that the atmosphere of the hospital was quite religious. "Prayers on the wards and nurses singing hymns." But the question of euthanasia did come up. "It was helping people. People who might linger in a miserable way might be given slightly more painkillers than was strictly necessary. It was quite well known."

When Dr Twort started, the NHS was very different from today. There was no ultrasound, no imaging techniques, primitive radiotherapy used radium which could be hazardous and there were no computers, which he feels has made a tremendous difference.

"But one of the biggest differences now, I think, is the great expectations on behalf of the population. The whole idea of demand and the confidence people have that they should get what they want. There is a greater moral responsibility now because of the problem of financing and the whole current debate over rationing."

Dr Twort is glad that he worked in the NHS all his life. Asked what he thinks it will be like in 50 years, though, and he raises his eyes to the sky. "Heaven only knows."

DR SAURABH JHA

joined the nhs in 1997

SAURABH JHA also decided to go into medicine, following in his father's footsteps. "I decided quite a long time ago I wanted to do medicine. I thought it would be a fairly promising career, although I didn't have a clue what it involved."

Dr Jha is a surgical house officer which means unless he has spent the night on call, he's expected to be in at 8am when he's working and will not finish until about 6.30pm. He works in a team of three, with two other house officers, and his main work is to do the two ward rounds every day. "We go through the list and see which of the patients are high priority, and which are low priority, and divide up the workloads. So at this stage in my career, I am not doing any surgery. My job is to look after the patients, take forward the paper work, discharge them and manage the follow- up."

He thinks consultants are less aloof than they used to be and that the doctor patient relationship has altered radically since Dr Twort's day. "It certainly has done in surgery. We explain all the options to the patient now and the relative merits of these options as far as possible, and get them to make the decision, although we obviously say which decision we would prefer that they take. But informed consent is now seen as a very important part of the surgical procedure."

Despite the increasing technological advances, he thinks that it is important to maintain a human side to the NHS. "The one thing I won't forget, the one thing I'm proud of, is when I was in medical school here, and there was a patient who was getting very, very frustrated because they had been waiting quite a few hours for their procedure and no one seemed willing to speak to them. So I just sat down for 20 to 30 minutes and managed to calm them down, and that's what I'm really proud of."

Does he feel that Dr Twort's fears about the army of clerks is justified? "I think bureaucracy is something that more senior people in the NHS than me have to worry about," he says tactfully. "It doesn't really affect me."

Looking back over the NHS for 50 years, he singles out two things as very important. "In technological terms, first the advance in day surgery so that people can go back home the same day as long as they're young, healthy and fit. The second advance is keyhole surgery which means that post-operative stays and complications have been very much reduced."

How does he think the NHS will be in 50 years to come? "I think there still will be an NHS which will survive. The people of England have got used to using the system and you can't take it away from them, although I think certain specialities will be more or less private, such as orthopaedics. I don't think we're going to become the United States, though. I think insurance companies have probably reached saturation point. You have to believe in the NHS to justify your presence working here" he says.

But he doesn't necessarily see himself in the NHS in 50 years time. "The financial rewards of private work would be welcome alongside the work you do for the NHS."