By the second decade, the NHS was beginning to settle down. Treatment was improving as better drugs were introduced. During this decade, the polio vaccine came in, dialysis for chronic renal failure and chemotherapy for certain cancers were developed.
There were, however, problems for both GPs and hospitals despite the development of a measure of trust between the professions and the Government. The Royal Commission on doctor’s pay alleviated some of the arguments which had caused problems during the first decade.
Negotiations between the Government and GPs leaders led to a review body award which provided a basis for the development of the modern group practice.
Better management became a priority. Hospital Activity Analysis was introduced to give clinicians and managers better patient-based information and divisions were created with the aim of grouping medical staff by speciality. Increasingly, though, the structure of the service was being criticised.
In the 1962 Porritt report, the medical profession criticised the separation of the NHS into three parts - hospitals, general practice and local health authorities - and called for unification.
While much had already been done to appoint consultants in the major specialities throughout the country, their skills were not matched by the outdated and war-damaged buildings in which they worked. Enoch Powell's Hospital Plan, published in 1962, approved the development of district general hospitals for population areas of about 125,000 and in doing so, laid out a pattern for the future.
The ten year programme put forward was new territory for the NHS and it became clear it had underestimated the cost and time it would take to build new hospitals. But, a start had been made and with the advent of postgraduate education centres, nurses and doctors were given a better future.
The Salmon report in 1967, detailed recommendations for developing the senior nursing staff structure and the status of the profession in hospital management. Then, also in 1967, the first report on the organisation of doctors in hospitals (known as the Cogwheel Report) proposed speciality groupings that would arrange clinical and administrative medical work more logically.
The variety of efforts being made at this time to reduce the disadvantages of the three part structure showed the growing acknowledgement of the complexity of the NHS and the importance of change in order to meet future needs.
Excerpt taken from From Cradle to Grave by Geoffrey Rivett. Published by the King’s Fund, 1998. (http://www.kingsfund.org.uk/) ISBN: 1-85717-148-9. Price: £25.00. Available from selected bookshops and the King’s Fund bookshop. Tel: 0171 307 2591.