As the NHS celebrates its 60th birthday, June Shannonlooks at Ireland's contribution to Britain's health service
BRITAIN'S NATIONAL Health Service (NHS) is 60 years old this year and, as one of the oldest universal-based healthcare systems in the world, it has a lot to celebrate. However, Ireland's significant role in its success it also worth commemorating.
Established on July 5th, 1948, by health secretary Aneurin Bevan, the NHS has long been feted as a true model of socialised medicine where all patients receive free treatment at the point of care, irrespective of their ability to pay.
Funded entirely by taxation, where the public pay according to their means, in 1948 the NHS had a budget of £437 million (€543 million) equivalent to £9 billion today. By 2007/2008 this figure had increased tenfold to more than £90 billion.
Since its inception, the NHS and the Irish health service have enjoyed a mutually beneficial relationship. It is estimated that by the early 1970s almost one in eight NHS nurses was Irish. The NHS has trained hundreds of Irish medical graduates over the past six decades who, on returning home, used this knowledge to improve the lives of Irish patients.
In return, Irish doctors, nurses and healthcare workers have dedicated all, or a large part, of their professional lives to the UK service.
One such Irish doctor is Tom Fahey, professor of general practice at the Royal College of Surgeons in Ireland (RCSI). Before returning to Ireland in 2006, Fahey spent 14 years working in the NHS.
"It's a national institution. I have very positive feelings about the NHS as a health professional, principally because of the issues of equity and free access at the point of delivery. From a GP point of view, I think it is a very strong, holistic approach to patients."
Both Fahey's parents were Irish qualified doctors who worked as GPs in Birmingham for more than 30 years and who, like hundreds of others over the past 60 years, contributed largely to the British health service.
According to Fahey, primary care in Ireland could learn a lot from the NHS, particularly regarding access and co-ordination of care for patients.
"The NHS changed in my professional time, there was a huge amount of investment in the Blair years that did make a difference," Fahey says. "This idea that the NHS is just a long waiting list, that did certainly occur in the early 1990s, but it had all changed by the time I left in 2006 . . . people got access to care very quickly if there was any suggestion that there was a serious underlying problem.
"You hear advocates of private healthcare saying it's too unwieldy and managerial-based [the NHS], it is not - there was a lot of flexibility in the later years because of the investment."
Like Fahey, Prof Frank Keane's father also worked in the NHS. The president of the RCSI's father was a GP from Ballina, who was one of an estimated 50 per cent of Irish medical graduates who went to work and train in the UK just before the second World War.
His practice was then taken over by the NHS in 1948. "The NHS was hugely supported by Irish trainees both on the doctor side and also hugely on the nursing side . . . the Irish have made a huge contribution to the growth and the success of the NHS over the years," he says.
Keane spent five years working and training in the NHS before returning to Ireland as a surgical registrar. "A huge number of us went over there both to train, because their standards were good, and we also had huge opportunities in terms of operating."
The contribution of Irish medical school graduates to the NHS continues today. Prof Sir Ara Darzi, the current parliamentary under-secretary of state at the department of health in the UK is a graduate of the RCSI. Earlier this year he launched the Next Stage Review final report on his vision for the future of the NHS.
According to Dr Martin Daly, GP and president of the Irish Medical Organisation (IMO), "many of our graduates were very grateful to have the opportunity to work in such a highly regarded system so close to our own doorstep. The vast majority of doctors, as the vast majority of people in the UK, still highly value their national health service in spite of some of its shortcomings," he says.
Daly, like a number of his British counterparts, is concerned at what he sees as the growing threat of corporatisation of general practice in the UK, due to proposals to introduce polyclinics across the country, with some reports stating that such clinics may be located in superstores such as Tesco and Boots.
"It would be unfortunate that on its 60th birthday that there are signs that the current Labour government are attempting to corporatise general practice in particular, but many services within the NHS," the IMO president says.
According to Fionan O'Cuinneagain, chief executive of the Irish College of General Practitioners (ICGP), Ireland has gained much from being able to look at and compare with the NHS. However, he says it is important to remember that the two systems are quite different.
"It is a comprehensive system, whereas in general practice in this country we have a public/private mix and hence you cannot directly replicate the NHS experience into the Irish situation, which is very often what the planners attempt to do without recognising the particular culture of general practice in Ireland," he says.
"Because it is a public/private mix, the management and control of the service is very much in the hands of the GP, as opposed to in the NHS. That in itself creates a particular differentiation. Also we haven't gone down the road, as yet anyway, of operating strictly to protocols and targets in primary care.
"I think having done that in the UK has had some positives in public health, but on the other hand it clearly has had a negative impact on the morale of general practice in particular."
Prof Tom O'Dowd, professor of general practice at Trinity College Dublin, spent 14 years working in the NHS. "The people of Britain want their NHS, they have a deep and abiding affection and respect for it, and for the staff who work in it."
According to O'Dowd, Irish people have been "the face of the NHS" and have helped to humanise the service for many patients. "I used to find it amusing that patients sought me out because I was an Irish doctor. They had an Irish doctor growing up and their mother told them if they wanted a good doctor, you had to find an Irish one," he smiles.
"The history of it is very important. It was set up after the second World War. There was a lot of levelling of classes. People coming back from the war said things must not be the same again.
"The NHS was one of the lasting and enduring contributions that their society made to changing things, and bringing in some kind of fairness into their society. It also was an acknowledgement that health is extremely important.
"The biggest thing we can learn from it is you can have universal healthcare for a very small proportion of your Gross Domestic Product [GDP] - 7-8 per cent of GDP - and they have a universal healthcare system at primary and secondary level."
Despite its many shortcomings, the basic principles of equity and free access to care for all in the NHS is something to admire and aspire to.
Hopefully for the patients and staff working in the system, these founding principles will never be pensioned off.