The NHS at 60: has the dream been matched by reality?

Sixty years ago, the world's first free, universal health service was born in Britain. But has the dream been matched by reality? The staff of Birmingham's Heartlands Hospital share their experiences of life in the 21st-century NHS

It is hard to imagine that, in the lifetime of our older citizens, babies born to poor families in this country were born at home because the parents did not have the means to pay for hospital care, and were frequently afraid, anyway, to go into places where people were ill and died. But the vast majority of babies born in Britain since 1948 have arrived in this world under the NHS's watchful eye; and nearly all of us, unless we are very unlucky, will have someone from the NHS on hand to make us as comfortable as circumstances allow as the time approaches for us to shuffle off the mortal coil.

It is hard to imagine that, in the lifetime of our older citizens, babies born to poor families in this country were born at home because the parents did not have the means to pay for hospital care, and were frequently afraid, anyway, to go into places where people were ill and died. But the vast majority of babies born in Britain since 1948 have arrived in this world under the NHS's watchful eye; and nearly all of us, unless we are very unlucky, will have someone from the NHS on hand to make us as comfortable as circumstances allow as the time approaches for us to shuffle off the mortal coil.

Between these two events, the NHS cures our fevers, mends our broken bones and checks our heartbeats – but it also drives us to distraction with its slow-moving and expensive bureaucracy. It is one of the world's biggest employers, up there with the Indian state railway, the Chinese army, and Wal-Mart. Its size leaves it permanently open to controversy. If there is a blunder in an operating theatre somewhere, or a patient is left neglected on a trolley in a corridor, it reflects on the whole service, and becomes a political problem for central government to solve.

The size of the NHS means that a decent pay award for staff puts the whole country out of pocket. Its cost is a perennial political problem that is impossible to resolve, because there is no limit to the amount that could be spent healing the sick, while there is a limit to what taxpayers can be persuaded to pay. From the outside, the NHS is like a ravenous monster devouring ever greater amounts of public money; from the inside, it is chronically underfunded.

Everyone complains about the NHS, but everybody needs it. There was a time, nearly 30 years ago, when Margaret Thatcher wondered if there was a better way of funding a health service, but realised that abolishing the NHS was too dangerous a proposition for any politician who hoped to be re-elected. Even reforming its sluggish bureaucracy is a perilous endeavour for any government. But it has had to adjust to an era when people have more money and less time to spare, which is why staff are being exhorted to adjust their working habits to suit patients, rather than expecting patients to fit with in with their schedules. So even after 60 years, barely a day goes by without some controversy blowing up around the service. Yet it is now such an established part of British public life, that we would be shocked to hear anyone suggest we get rid of it. Can you imagine Britain without the NHS?

David Morgan, 51, consultant ear, nose and throat surgeon

There isn't a day when I don't want to come in. Sometimes you can make a difference and sometimes you can't, but the days are always rewarding.

The NHS used to be frustrating, but there is more of a can-do attitude now. I qualified in 1981 and in the first 10 years there were all these barriers to change. The biggest challenge over the past couple of years has been hospital infections, which we're now getting on top of. Now we need to sort out medical careers. I don't think you can train doctors to a high standard by reducing their hours, and the EU Working Time directive has had a serious impact on training and safety. I grew up in an environment where we did 110 hours a week and I can't remember patients dying of errors. I'm not convinced doctors doing 40 hours a week makes it a lot safer.

The pay is great for a consultant. We have a good pension and you have a job for life. How could it be better? Most people will leave or go part-time at about 60. No one wants to be operated on by a 65-year-old surgeon.

Lorna Grinnell-Moore, 50, matron of urology and thoracics

The modern matron is not Hattie Jacques, but my approach is different – I'm known as "Comply or Die". There are still nurses who believe doctor is God. They don't feel confident enough to challenge the supposition. To me, they're just men and women who couldn't do their job without me, and I couldn't do my job without them. If you ask my consultant colleagues they'll say the same.

I love my patients and the camaraderie. I like it when you can walk down the ward and a patient says: "Hi matron, isn't it clean in here?" And I think: "Ooh, Panorama. Get back here and hear what they're saying now!"

The NHS is the best thing ever invented in this country. Sixty years ago penicillin had only just been found and people were still losing hands using X-rays. Now we have expensive equipment and drugs and a growing and ageing population. The NHS vision is changing but we've got to work out how it will survive into the future.

Robert Sayers, 50, cleaner

I've been working in the hospital for five years. I used to be a road sweeper, but I was made redundant. I clean the building where all the social workers are, and the occupational health building too.

I grew up in Birmingham and I live three miles away, in Tyldesley, with my white cat, Arthur. My twin, Tony, lives nearby. I come in by bus.

This is a nice place to work – you get to know everyone. I've always worked on my own and I like that, as you can work how you want, but I do know some of the other cleaners. Satisfaction and working with people you like is important. I'm happy in my job and I think the NHS is all right. I've been treated here once: I used to have two lumps on my head, and in 2000 I found out they were sweat glands and had them taken off. They wrapped a huge bandage round my head and neck. I felt like a mummy.

Chris Morrell, 48, play specialist

I'm the nice lady. I work with children to make their hospital experience better. One young lady had to have a scan and she didn't turn up to appointments because she was scared to come into hospital. I rang her mum up at home and she brought her daughter in to my playroom, where there are no doctors and nurses. We talked it through and she went away happy, and turned up for her next appointment. I went with her and she had the scan without sedation.

No two children are the same. If a child is upset, I can jump up and down and blow as many bubbles and pull as many funny faces as I want, but it doesn't always work. Children with cystic fibrosis come in for two weeks every three months and they're having intensive physiotherapy and antibiotics and can get traumatised. I'll sit with them while they're having blood samples taken and lines fitted. I arrange visits from footballers, and we have a magician, too. I also do a lot of fundraising – there is no budget for the little extras.

Mohammed Mukadam, 39, west midlands ambulance technician

I do 12-hour shifts, so I work for three weeks and then have a week off. They're long days, but the shifts mean I get time with my children.

There are two people in each ambulance and you could end up anywhere from Walsall to Wolverhampton. The Government wants one paramedic and one emergency care assistant – the driver – in each ambulance, but that's not always the case. I am a technician and we know as much as the paramedics but there are some drugs we can't administer.

It's only as stressful as you make it. I went to a bad accident recently. There was a fatality. You have to do what you think is right at the time. He was 19 and we worked with the body and brought it in, but he died. If the person is obviously dead and there are limbs hanging here, there and everywhere, then you wouldn't work with it, but if there's any chance it is alive we will do all we can.

Riaz Janjua, 51, equal access facilitator

Hospitals aren't just about doctors and nurses. Equality and diversity, which is often thought of as a bolt-on, is part of providing care in the hospital, by making sure everyone's linguistic and cultural needs are met.

We used to have predominantly south-Asian communities living in this area, but with the EU opening up and new groups arriving from Kurdistan, Iraq and Somalia, the demographics have changed.

We have in-house interpreters. Once we dealt mainly with five south-Asian languages, but in the past six months alone we've had to provide face-to-face translation services for 43 different languages.

I was in the petroleum industry back in Pakistan, but the NHS has given me the opportunity to develop myself. My wife works for the NHS as well, and is joining this trust later this month. We have a lovely 18-year-old daughter who has just finished her A-levels and is taking a gap year. We live very close to the hospital, so you could say I have a finger on the pulse.

Dr Alan Jones, 56, consultant pathologist

When I started off as a cardiology registrar, if someone came in with a heart attack we would put them to bed with some heroin. Now they’re whipped into the catheterisation lab and have an angiogram and angioplasty there and then. The interventions are far better now. I do general medicine as well as pathology, which is unusual. As a junior doctor in the Eighties, I was doing 122 hours aweek, so I gained sufficient experience to become trained in both. The training is a more regulated now, to get people through more quickly. It’s not deskilling, but there's no substitute for experience. As clinical director of pathology, I organise a budget of £18m and the trust is very keen to know how much it costs to break wind in the morning as opposed to the afternoon. The NHS might seem like a shambles but it bears no resemblance to theway it was when I was training. The degree of organisation and focus on quality patient care has improved dramatically.

Paula East, 48, senior midwife manager

I qualified as a midwife 23 years ago, and women's expectations have really changed in the past 20 or 30 years. Back then, if the midwife told you to do something, you would just do it. Now women are a lot more informed and often come in with something they've read on the web and ask about it.

I'm married and have a son – I misbehaved during my own labour and ended up with an emergency Caesarean. In an ideal world, a midwife would be available to a woman at any time during her pregnancy, but the reality is that's just not possible. Our ladies assume we are on call 24 hours a day, and to a certain extent we are – there is a lot of patience involved.

I have 100 midwives to manage. Sometimes I wonder why I gave it up to come into the office. I do miss the births, but I still attend some. I was on call two weekends ago and had a very nice calm water birth at home.

I enjoy working for the NHS. My colleagues are very supportive of me – especially at the moment, as I'm stressed out because my father is not well.

Diane Tomlinson, 50, infection-prevention nurse

I've been in infection control for 25 years. When I started, our department was a Cinderella service – you'd be on your own and everyone thought infection control was just your job. Now everyone in the hospital recognises it is a serious problem and that it is everyone's job, not just the job of infection control. People feel free to challenge others about hygiene. That never would have happened five years ago – in any trust.

Unfortunately, hospitals are still very hierarchical, which is a problem. I lead a new infection-prevention team, with an increase from four to 11 nurses, which reflects the money being put in. There's no way I could do less than a 12-hour day, but that's my decision because it's a new service and I want it to work.

My husband says that you could operate in my kitchen – but there is a big difference between hygiene at home and in a hospital. When I started, standards were awful, and we dealt with outbreak after outbreak, which isn't recognised by the public. They think there has been a slip in standards.

Adrian Stokes, 37, finance director

The NHS seems to go in boom and bust cycles. I don't think there's a shortage of money, but there is a need to spend it wisely. If you go back two years, it reported a deficit of about £600m, and all the stories were about money and certain drugs which were being prescribed by primary care trusts. Step forward a year and the NHS has a surplus of close to £2bn.

I was on the NHS graduate scheme and worked in the private sector for a year, but it wasn't very rewarding.

It was a good move to get a clinician like Lord Darzai to do the hospital review. What the report says about preventing illness is an important step. In America, where everything is insurance-based and they have a financial incentive for people not to come into hospital, they invest heavily in walk- and bike-to-work schemes, and five-a-day nutrition schemes – all those kind of initiatives that don't pay dividends immediately.

Whatever my kids are doing at school is going to influence whether they end up being obese, or whether they smoke – and whether they're going to cost the NHS a lot of money.

Claire Chapman, 35, personal assistant

I worked for JCB in Staffordshire for nine years and thought everything was champagne and helicopter rides. It was a bit of a shock when I came down to Birmingham.

Any industry is high stress, the only difference here is the resources issue. Still, you just have to adapt and get stuck in. I didn't come here for the money. It was an opportunity to step out of management.

I do anything from typing reports, arranging meetings and helping out with patients to organising the summer barbecue and fixing travel. Sometimes the level of work gets quite high and I wish I could split myself into two, but the level of support from the senior sisters is amazing.

I've only been here for 18 months, but I've built up a bank of contacts around the hospital who I can call on whenever I need a favour. I feel like I've been here for years. I'm the deputy editor of the hospital's in-house magazine, too.

I live with my partner, Scott, and we have three lovely foster boys. Juggling that and a job is full on, but I'm lucky, as Scott is the full-time carer. We moved here because we used to come clubbing in Birmingham a lot, but now I'm winding down and might want to go back to the countryside.

Kellie Jervis, 37, emergency department senior sister

Watching Casualty probably fostered my interest in emergency medicine, but what you see on television certainly isn't reality. I love the fast pace, the adrenalin rush and being able to just get on and do things.

We have a lot of transport links round here – the airport, rail and Spaghetti Junction – so I do see a lot of nasties. A few years ago, someone was shot at close range not far from the hospital and came in with a really bad head wound. We had armed police running around the department and had to shut it down as a crime scene.

It's very difficult when someone dies, and it's not unusual for us to shed a couple of tears with the family. There isn't any harm in showing them that you're human. We have lots of student nurses in Birmingham, and they're the ones you need to watch if you have some nasty trauma or a cot death in, as it will hit them hard.

The pay has improved but we earn it – 109,000 people will come through our doors this year alone. Our workload goes up by roughly 4 per cent each year. Whatever measures have been taken to stop unnecessary visits to A&E haven't worked.

Derek Hoare, 53, porter

I've been working at the hospital for five years, after too many years on the road as a long-distance lorry driver. Porters run the post room and take deliveries all over the hospital – everything from single letters to medical records. They're a friendly sort of crowd who work here, the atmosphere is good and you get to know a lot of people. That said, I do a lot of weekend work, and I don't enjoy everything we do – like moving bodies. Still, it has to be done by someone.

There are always going to be moans and groans in a large organisations, and hospitals are no different from anywhere else. People tend to gripe about wages mainly, and about the hours and the pressures they work under. But I think the majority of people who work here enjoy it.

I don't earn a great wage, to be honest – still, it has got a bit better since I first started. Between the unions and the trust they are slowly increasing salaries, but considering the work and the pressure, I do think that we're underpaid.

Mark Goldman, 56, chief executive of the heart of england

foundation trust

I don't think the NHS needs more money – we can deliver our ambitions on what we have. The funding deal for the NHS runs out at the end of this year, and I hope that the Government maintains spending into the future.

It sounds a bit soppy, but it is the staff who inspire loyalty to the NHS. They are very interesting and wonderful people, and the reason it has lived on for 60 years.

I work as much or more than when I was a surgeon, but it is a big transition. As a clinician, people thank you for saving their life. As a manager, people say quite different things, which are sometimes quite hostile and personal. That's something you could do without, but you're public property if you're an NHS manager.

Although I like my weekends, I am less enthusiastic about holidays. I earn in excess of £200,000 and they don't pay me that kind of money not to make sure the organisation works well.

Graham Crawthorn, 56, shop assistant

I'm a people person. You have to be to do this job. A hospital shop is special shop because of the range of customers: eminent surgeons and doctors, the domestic staff and the administrators. Mingled with that you've got the visitors and patients and sometimes you're serving people who look very poorly. That's not what you would normally get in a shop.

We are a step towards the outside world when people are getting better. I get to know the staff and have a chat. I might ask the registrars what their specialisms are, and you can always spot a new father buying flowers. The shop is run by the Women's Royal Voluntary Service. I worked in HR and was a carer for my mother before starting here 18 months ago. It's been interesting seeing the range of jobs that people do.

The NHS must have been created just a few years before I was born. I think it's a marvellous institution.

Dr Dev Banerjee, 39, consultant in respiratory medicine and sleep

Sleep apnoea – when people stop breathing at night – is the largest part of my work, and we're going to see a lot more of it with the obesity epidemic. My referrals of young people with sleep apnoea, diabetes and obesity have gone up from 12 a week to 30 a week. Obesity is the biggest public health disaster this country will face in the next 20 years.

The Government is trying its best in terms of treatment facilities and increasing the number of specialists, but it has to go further – we need a cultural change, one that takes place in schools, in advertising, and in the responsibility of the individual.

Since arriving back in the UK in 2004, after working in Sydney, there has been a drive for quality and equality and fairness throughout the NHS. The funding for sleep apnoea is now available without any geographical disparity and public health awareness of sleep conditions is improving slowly. Things are good in the NHS. Targets improve quality and get people seen more quickly. There is quite a lot of stress, but if someone I've treated is working again, that makes it worthwhile.

I don't work crazy hours like some colleagues. I have two children, so I try to get home by half five as there are nappies and feeding to deal with.

Julia Reese, 24, junior doctor

"I have been a doctor for 10 months. I work on the infectious disease ward, where we see a reasonable number of TB and malaria cases.

You don't really know what it's like until you get going. When you have patients who are particularly sick, you don't look forward to talking to their families. At medical school they made quite an effort to teach you how to deal with bereaved relatives and angry relatives, but most of it comes with experience.

There are problems in the NHS, as there are with any huge organisation, but all the criticism it gets really annoys me. I don't think everybody in this country appreciates how lucky they are to have free care. Yes, there are waits and things aren't perfect. Everyone acknowledges that things won't happen as quickly as if you go private. But you will get the investigations and the care that you need.

I spent my elective in Tanzania in a hospital where they do incredible work but have no resources. That's what a real Third World health service is, not this one."

Roy Boffey, 60, chaplain

I came into this world at Great Ormond Street Hospital, and after 60 years of the NHS, here I am just celebrating my 60th birthday, at Heartlands Hospital, as a chaplain. I owe my life to the NHS and now I'm giving back to it. You find a lot of people in the health service have had their own encounters with tragedy and illness.

We have 10 chaplains across three hospital sites. Two of them are Muslim, and some are Roman Catholic, but the centre at Heartlands is open to all.

We're here for the whole hospital, to offer pastoral care. I suppose we're here to nurture people who've got faith, and for those who have no faith, because very often they're deep thinkers, and what they've rejected is not true faith but religious rules and the small-mindedness of religious structures. When it comes to life and death - road crashes, say, we're all the children of God.

I think a bit more TLC would lift the morale of the health service to where it needs to be, rather than adopting the carrot and stick approach.

Sana Shahid, 22, fourth-year medical student

It's a bit of a cliché, but I want to be a doctor because I like to spend time with people in need, and because I love science. I want to go into surgery next, so I spent an extra year studying anatomy. I worry that some students don't take it seriously enough.

A lot of women opt out of surgery because of the hours. It is being made more accessible, because there's an appreciation now that you have to balance your family life and career. My mother's a surgeon, so she is an inspiration. When she had me and my siblings, she took some time off. It's difficult but possible to have a successful family life too.