Structure, Finance & Service
History of UK Healthcare:
UK healthcare is unique in the world, often admired but rarely copied. It is 95% state funded and free at the point of delivery, with few checks on patie[p
UK healthcare has two unequal partners: General Practice and Hospital Medicine. WIth different backgrounds, different histories and different cultures, they lie alongside each other in an uneasy truce.
Origins of General Practice
Origins of the Hospital Service
It is common knowledge that the NHS was set up by the Labour Government after WWII. What is less appreciated is an understanding of how it came. to be the way it is. It reflects my family and my family reflects the UK Health service, coming as I do from a medical family. Indeed at one point, there were enoughpractising doctors in our family to run a small hospital.
My Grandfather, Dr Glendinning Sinclair Miller was a doctor, joined up for the first World War, ran field hospitals and received medals and citations for his own bravery and that of his men in his brigade. After the war, he went back to Harrogate and set up the Duchy Clinic. Through the clinic, with its associated laboratory, he brought blood transfusion to the north of England. Undoubtedly his war time service strongly influenced the way he worked and, as ever war brought medical advances, not least of which was a better understanding of blood transfusion.
My father, Dr Robert Glendinning Miller was also a doctor, he was at medical school during the early part of war, The London Hospital. He was a pacificist but when the call came, and he was enlisted in India Army Medical Corps and then the Chindits. He spent his war in Burma behind enemy lines under the command of General Slim Windgate. He received the Burma Star and Chindits medal.s
My father, Dr Robert Glendinning Miller was typical of the generation of doctors who set up and ran the NHS, Needless to say, the NHS reflected their experiences of setting up and running hospitals. That is the NHS was like a gigantic field hospital. Very good at medicine and trauma, less good with the long-term management of chronic conditions – who would have been sent home to convalesce in the nursing homes of `Blighty.
Even now, the NHS does best in trauma, acute care, and logistics but is less good at managing long-term outcomes, reflecting its military background. Of course, there are now three generations of consultants and a dramatic change in medical education – called Modernising Medical Careers in 2004, that have cut it off from its roots. Now the service is so far from its original purpose, that it has completely lost its way and is being pulled apart by a string of competing interests. Indeed we are the worst in Europe and worldwide, only slightly better than the US. (OECD Mirror Mirror) ref.
My family history through several generations of doctors, reflects medicine, the world wars and current NHS. I myself, Dr Elizabeth Sinclair Miller have worked in the NHS for forty years, before finally handing bach my licence to practice but not my registration in 2016.