Description

The Public Health and the NHS is a well-informed and readable review of the development of the NHS, especially the early years and the situation prior to the NHS. I particularly liked the personal, anecdotal style. For example, on Archie Cochrane, “he was one of the well-off, communist sympathising medics of South Wales. He had a garden scattered with Barbara Hepworth statues and a beautiful collection of paintings. Curiously, after the war he never published a randomised controlled trial” [p55].

The question and answer format makes the text accessible, with a few clear and relevant diagrams. Unfortunately the answer does not always correspond to the question posed. More importantly, the books central argument is not well defended. The book starts with “my main idea in writing this book is to suggest that health services exist in place of fear”, and ends with “cuts to the NHS…engender fear…it is the main job of the NHS to relieve that fear”. Inbetween however, the author makes little attempt to advance his argument. It is almost as if the idea was added on afterwards to his excellent overview of the development of the NHS.

He brings together the ideas of Ian Kennedys 1980 Reithlecher, Illich, McKeown and the Black report on inequalities [the book was published shortly before the Acheson report] in support of his argument that the NHS and a powerful medical profession have not affected morbidity or mortality, but I was left confused about the link with relieving fear.

The author has obviously thought deeply about the problems facing the NHS, and hints of radical solutions: “there is little questioning about the central philosophy of developing expensive treatments [such as cardiac transplantation] for such small numbers of people or the right of the bio-engineering and medical professions to develop such approaches as long as they appear to work at a technical level” [p114]. These ideas deserve more than hints and I was disappointed that the author missed the opportunity to develop them into clear recommendations. A prescription for change in the NHS would have made the book much more than an entertaining historical overview.