National Health Stories

Like a much loved elderly relative, the National Health Service has endured more examinations and diagnoses than any other public institution.

When Bevan first launched it, he knew that there would never be enough money to meet the overwhelming need, and successive health ministers have used a variety of tactics to try to manage its chronic health problems.

Sally Sheard looks back at this intensely political organisation and asks Jeremy Hunt, the then Secretary of State for Health and Social Care, and longest serving, why health ministers rarely learn from history.

Producer: Beth Eastwood.

For many, the typical image of the British nurse includes their earthy sense of humour and resilience. They've been trained to conform to hospital rules and hierarchies, yet always find ways to cope with the pressures of this demanding career. But in recent years, this image has been shadowed by darker tales of nurses' lack of compassion. Sally Sheard explores the changing roles of nurses in the NHS: now they are all graduates and are likely to be found diagnosing broken bones in an A and E department leaving the caring side of the job to healthcare assistants.

Screening the British public for the presence of disease, took the health service in a radically new direction.

It was no longer just about symptoms. Certain diseases could be detected before a person even knew anything was wrong.

Screening, however, has been fraught with controversy and, over the past three decades, breast cancer has often made the headlines.

The arrival of Britain's breast screening programme with mammography, in 1988, was welcomed. As it became established, however, some experts highlighted problems with the programme and began to question its value.

Fewer women were being saved than first predicted, they claimed, and some women were being unnecessarily diagnosed and treated for cancers, detected through screening, that were not life threatening - what's called over-diagnosis and over-treatment.

Today, over-diagnosis & over-treatment is generally accepted and information on over-treatment is available so that women can make an informed choice.

Producer: Beth Eastwood.

During the 1980s and 1990s, patients contracting infections in hospital, that antibiotics could no longer treat, dominated the headlines.

The strict hygienic regimes, so beloved by matrons since the Nightingale era, had been undermined by a reliance on antibiotics. When one bacterium became resistant to an antibiotic, there was always another to fall back on.

But when patients became infected with a bacterium which had become resistant to Methicillin, a crucial antibiotic in the health service's armoury, the defence against the bugs began to crumble. Methicillin-Resistant Staphylococcus Aureus, or MRSA, thrived in NHS hospitals and began to spread, largely unchecked, from patient to patient.

As the numbers of patients contracting MRSA spiralled, the cleanliness of NHS hospitals, and their poor infection control, came under close scrutiny. Clostridium Difficile also emerged, alongside MRSA, as a source of public anxiety.

It was time for the NHS to clean up its act and tackle the spread of antibiotic resistance head-on, with the infection control nurse leading the fight.

Producer: Beth Eastwood.

At the start of the 1980s a mysterious disease, AIDS, appeared in gay men. There was fear that it would become a new plague. Sally Sheard tells the story of how activists, doctors and politicians worked together to stop the disease spreading.

Apart from a handful of individual doctors who saw gay men with Kaposi's sarcoma and a pneumocystis pneumonia,, there was no reaction from the government in the early years of the AIDS epidemic. The gay community took matters into their own hands and in 1982 the Terrence Higgins Trust was set up, named after one of the first men to die from AIDS, to give advice. By the mid 1980s Donald Acheson, the Chief Medical Officer, realised he had to find a policy to tackle the new disease that would be accepted by the medical profession, the gay community and government. One of Donald Acheson's great achievements was persuading Health Minister Norman Fowler that AIDS needed serious attention. This approach culminated in the famous tombstones advert voiced by John Hurt that proclaimed "don't die of ignorance".

In a series tracing the decisive moments in the life of our National Health Service, historian Sally Sheard explores the recurrent crises caused by lack of funding.

In 1987 a shortage of nursing staff lead to the death of a baby whose heart operation had been cancelled five times. Nearly 40 years on from the start of the NHS, the resources couldn't keep up with the demands of the patients. The government published a White Paper, Promoting Better Health, with an emphasis on getting GPs to do more prevention and increase their list size, as well as charging for eye and dental tests. Margaret Thatcher had already brought in the managing director of Sainsbury's Roy Griffiths to improve management in the NHS. By 1991 there was an internal market in the health service.

In a series tracing the decisive moments in the life of our National Health Service, historian Sally Sheard looks at reports that highlighted the inequalities in health service provision around the country. The Black Report was commissioned by a Labour government but the time it was published in 1980 Margaret Thatcher had come into power. The findings that people in deprived areas had poorer health than those in wealthy regions were not accepted. A second report commissioned by the Health Education Council at the end of the 1980s suffered the same reaction. Over that decade health differences increased. It wasn't until Labour returned to power in the mid 1990s that inequalities were taken seriously by government.

In a series tracing the decisive moments in the life of our National Health Service, historian Sally Sheard looks at the arrival of the babies people never expected to see - conceived outside the human body - the miracle of IVF births.

The NHS thrives on innovation, but sometimes it needs a more personal determination to keep going in the face of years of multiple set-backs. Both doctors and women looked in vain during the 1960s and 70s for a solution to infertility. Finally in 1978 Patrick Steptoe and Bob Edwards made the key breakthrough, and Louise Brown became the first of thousands of IVF babies. Their success meant that by the 1980s there were ethical dilemmas: how to limit multiple births, like the Walton sextuplets, and whether IVF treatment was a valid part of a National Health Service.

In a series tracing decisive moments in the life of our National Health Service, medical historian Sally Sheard reveals how Cecily Saunders and her modern hospice movement forced the NHS and the public to plan for a 'good death'.

Up until the 1950s, doctors focused on curing illness, not supporting people at the end of life. Cecily Saunders, a former social worker, was so appalled by the lack of medical care available for the dying, that she decided to re-train as a doctor.

While her long-term goal was to get the health service to embrace care for the dying, she began her mission outside. In 1967 the world's first modern hospice, St Christopher's, opened its doors, with funds she'd raised.

Dr Mary Baines, who joined the hospice soon after it opened, recalls how she helped Saunders turn hospice care into a respected medical discipline and bring rigour to the treatment of pain.

Meanwhile, Saunders also ensured that her 'modern hospice' movement was embraced by the NHS, pioneering home care for the dying and introducing 'palliative care' teams into hospitals.

Producer: Beth Eastwood.

In a series tracing decisive moments in the life of our National Health Service, medical historian Sally Sheard reveals how the little-known campaigner Barbara Robb exposed glaring gaps in the care of the mentally ill, forgotten in the vast long-stay institutions.

'Mental hospitals', as they were then called, had long been out of sight and out of mind, a low priority in the cash-strapped NHS.

Health Minister Enoch Powell's famous 'Water Tower' speech, in 1961, announced the mass movement of long-stay patients into the community. His optimism for this plan was buoyed by the new generation of psychiatric drugs developed in the fifties.

But nothing changed, until Barbara Robb went to one long-stay institution to visit an acquaintance. She was so horrified by the conditions there that she took up the fight for its voiceless patients.

Her campaign triggered a nationwide investigation, supported by NHS whistle-blowers and patients' families, forcing the government to bring in regular hospital inspections. Robb's legacy also lives on in the more open culture in the NHS that she brought about.

Producer: Beth Eastwood.