An Editorial in this week’s issue of The Lancet takes Gordon Brown to task for jumping on the bandwagon of the birthday of the UK's National Health Service (NHS). July 5 will be the 60th anniversary of the foundation of the NHS, but its future depends on a sharper scientific focus on health-system reform.
Gordon Brown’s reiterated plans for an NHS constitution, in which the public assume responsibilities in return for rights to health care, are likely to be empty rhetoric says the Editorial. The constitution is based on a prevention/treatment dichotomy that is false and it reinforces the general practice/specialist divide, “a step that is desperately anachronistic” comments the Editorial.
While political devolution has led to four very different NHS systems in England, Scotland, Wales, and Northern Ireland, with huge differences in service provision, ministers have failed to capitalise on the lessons from each approach. This demonstrates one of the fundamental problems facing the NHS—that it is not joined up in its culture and planning. Medical training in the UK has faired little better with no coherent educational approach. The Editorial calls for a radical change from the archaic apprenticeship system for training doctors towards a system based on best practice such as the education-based systems linked to universities and academic medical centres in North America.
The Editorial concludes by questioning whether recent reviews of the NHS calling for an evidence-led, comparative health-systems approach “can survive the Department of Health’s preference for centralised ideology over professionally led, devolved, and evaluated innovation.”
In an accompanying Comment Dr Chris Ham (University of Birmingham, UK) reflects on his time as director of strategy at the Department of Health in 2000–04 and looks at the actions needed to tackle the main challenges confronting the NHS today.
He says: “Ministers need to empower doctors and other clinicians to create an NHS focused on the maintenance of health and not just the treatment of sickness, and a system that is able to rise to the challenge of chronic disease. When current policies are leading to greater fragmentation, a sea of change is required…Clinically integrated systems need to be at the heart of change, recognising that a ‘21st century health system needs the most skilled doctors in the world working alongside general practitioners in the community, as well as specialist hospitals’.”
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Comment Dr Chris Ham, University of Birmingham, UK. c.j.ham@bham.ac.uk
Journal
The Lancet