Chris Roseveare is a Consultant Physician in Acute Medicine at University Hospitals Southamption, and is Editor of Acute Medicine Journal. He tweets at @CRoseveare
Shortly before my grandmother died, at the age of 90, she told me that she felt fortunate: fortunate to have maintained her health for so many years – and fortunate that the NHS had been there for her when she needed it. Not that she had ever been a great user of the Health Service – a thyroidectomy and essential thrombocythaemia required a few tablets, periodic blood tests and infrequent visits to the haematology clinic – but overall Peggy was right to feel lucky.
She was, of course from a generation which had lived through challenging times – she brought up two children, while her husband fought Rommel in North Africa, and endured the subsequent rationing that is hard to imagine in today’s society; she was a tireless fundraiser for the Royal British Legion and Women’s Royal Voluntary Service, for which she was awarded a well-deserved MBE; until her mid-80s she delivered Meals on Wheels, in her Morris Minor, to those Sussex residents for whom time had been less kind. After her own mother had died young, she had to endure the death of her own daughter from ovarian cancer; when her husband suffered a dense left middle cerebral artery stroke she drove daily to his nursing home for 2 years, to sit with him, help with his meals and provide personal care. She would never admit how these events must have affected her: a true exponent of the British ‘stiff upper lip’.
But Peggy felt fortunate for another reason: she was from the generation who still remembered the time before the NHS existed; the time when healthcare was based on ability to pay rather than the needs of the patient. She spoke at times about the sacrifices which people had to make in order to get the treatment which was deemed to be required; things which we now take for granted, such as maternity care or visits to the GP, would have to be funded out of an already stretched household budget. Undoubtedly this had a major influence on her own use of the healthcare services; she knew that the NHS would be there if she needed it, but would not have visited her GP unless it was ‘really necessary’. Peggy understood the limitations of the service – the fact that resources were not unlimited and needed to be shared equitably; she just could never quite believe that she might be the one who deserved her share. She would never have complained – on the occasions when appointments were cancelled or delayed, or mistakes were made, she was sure that ‘everyone had done their best’. If ever she did call out her GP, her immaculate house would be cleaned in time for his arrival. She would have been mortified if she had been too unwell to offer him a cup of tea before he left – to see his other ‘more deserving’ patients.
As the NHS reaches its 66th birthday we must remember that the numbers of patients who remember the time before it existed is falling; the current octa- and nonagenarians will soon be replaced by generations of patients who were too young to appreciate the sacrifices that were required in the days before 1948. It is much easier to take for granted something which we have never had to manage without. In celebrating this landmark in the history of our fantastic National Health Service we must also celebrate the lives of those who have, undoubtedly, contributed to its longevity.
Peggy’s final days were mercifully swift; as someone who had given so much to so many for so long, she would never have wished to be dependent on others, nor for her life to be extended. A fortunate end, indeed, to her long and fortunate life.