Friday, 8 January 2010

Wealth of Difference between the NHS for Rich and Poor

While I was checking files from my old pc to see which should be transferred, I came across this 6 year old article from The Scotsman written by Dr Ian McKee.

“MY FIRST senior partner was an independently minded Highlander, loved by his patients but viewed with caution by those in authority.

Returning from the war, Allan set up surgery in an old farmhouse in what were then the green fields of the Sighthill area of Edinburgh. He set to, digging the garden and decorating the house, pausing only when a patient called by for a consultation. There was a big party when his list size reached the magic figure of 100, a far cry from the 11,000 registered patients when I joined 24 years later.

I still have the accounts book for those early days. The practice was viable only because of a contract with the Ministry of Labour to perform a variety of examinations, many on servicemen wounded in action. But gradually, here and there, were recorded small sums ... 5 shillings … one guinea … as the practice grew and folk began to consult him and his wife, who later joined him.

Allan hated levying bills. He was no businessman and often forgot to chase debts, especially if he suspected a patient could not afford to pay. In those days, some had to go without food so a sick child could be treated.

The next big party was held when the NHS came into being. From then on, the accounts become much less interesting. Gone are the small sums and individual names, all replaced by much larger sums coming from the NHS direct.

Allan was delighted. At last, he could concentrate solely on medicine and leave financial matters to someone else. And treatment no longer depended on ability to pay.

Something else was assumed at that time. A truly national health service would concentrate resources where they were most needed, not just where the money lay. But, alas, that was one ideal too many. Today, we not only still have gross inequalities in health, they are widening. Your chances in Scotland still depend very much on where you were born and into what social class.

Much lip service is paid to banishing health inequalities. A document concerning the area of Edinburgh in which Allan used to practise, and I still do, lists many praiseworthy activities. Community events, tackling violence against women and children, promoting healthy eating; you cannot fault any of them. But we know the root cause of much poor health is the poverty all around us.

If you don’t know how you are going to clothe your children, let alone buy them Christmas presents, it is easy to let good health slip down the list of priorities. It is difficult to cook a pan of nourishing broth if you don’t have a cooker, or the power card has run out.
Not that those who run the health service should be complacent and blame all the problems on the outside world.

The NHS is still basically a middle-class organisation run for middle-class people.

There are more heart problems in poorer areas of Edinburgh, yet those living in more prosperous suburbs are investigated and treated sooner. Poorer communities have more babies born prematurely, underweight and with a higher chance of dying at or near birth, yet our community midwives are based according to population and not need. The need for first-rate general practice services in communities like Pilton or Muirhouse is self-evident, yet GPs working there are paid less than in the leafier suburbs.

If you really want a health service that delivers high-quality health care where it is most needed, it is quite simple. Devise a pay structure so that the cream of doctors and all other health workers want to work where the challenge is greatest. Postcode hospital appointments so poorer people are seen sooner. Distribute health resources according to need and not just per population.


It will never happen, of course. There are no votes in it and powerful vested interests in opposition.

But I know this is the sort of health service that Allan would have wanted.”

Why did I have this article saved? 

The doctor he writes about, Allan, was my uncle and he was so right about the National Health Service we needed then and need now.


  1. Much wisdom, no doubt, but I have never accepted the "poverty" (in UK terms) means poor health line. Healthy food is cheaper than unhealthy food, and the officially "poor" (ie on bnefits) seem to spend plenty money on McDonalds and chip shops and fags and booze. I reckon the poorer I got (within reason) the more healthy my diet would be.

  2. Andrew

    I'm surprised. I hadn't expected you to take the simplistic line. There have been many studies linking poverty, social deprivation and low social class to reduced health outcomes (e.g. increased mortality).

    That you would eat more healthily and more cheaply as your income reduced doesn't invalidate these findings but probably says more about your living your life out of poverty and deprivation.

  3. Hi Calum, I don't at all doubt the link between poverty, social deprivation and low social class and reduced health outcomes (e.g. increased mortality). That link is obvious. But drawing the conclusion that eating healthily is expensive is what I say is wrong, because it is not. The poor choose to eat (and drink and smoke) unhealthily. It is a choice (made for a complex mix of reasons) not a consequence of healthy food being expensive, because it is not, it is, I repeat, much cheaper than the stuff that most of our financially poorest people choose to eat.

  4. Rereading my initial comment, I could have been clearer about what I was trying to say. I do accept that poverty is linked to poor health, but I do not accept this is because healthy food is expensive, because it is not.

  5. Andrew,
    I'm with you on this point.