Dusk in the city

 

A month of Glasgow studies by Islay McLeod

 

6. Al fresco dining in Gordon Street

 

 

The story of a dying

prisoner tells us why

the NHS needs to be free

 

Steve Tilley

 

Walter Humes's excellent article 'Are policy decisions really based on "evidence"?', is timely. I urge SR readers to consider its arguments in relation to the Health and Social Care Bill now being debated in the House of Lords.
     Allyson Pollock and colleagues (formerly University of Edinburgh, now Queen Mary, University of London) claim that 'under the bill discretionary, non-universal, non-geographical powers will be the basis of commissioning functions and not as now comprehensive, universal, geographical duties', and 'despite [the bill] retaining the wording with respect to the secretary of state's principal duty to promote a comprehensive health service throughout England, the mechanisms whereby it can be given effect are radically weakened' (submission to the House of Lords, 11 October 2011).
     This threat to fundamental principles of the NHS should be resisted by all who do or may depend on the NHS for health care, not just folk living in England. Walter Humes's article brought to mind two stories about the 'father' of evidence-based medicine, Galashiels-born Archie Cochrane:
     In his book 'Effectiveness and Efficiency' (1989) originally published in 1972, Cochrane wrote: 'When I was a medical student in London in the 1930s...there was to be some rally about the possibility of a National Health Service in some London suburb, and I decided to go alone with my own banner. After considerable thought I wrote out my slogan: All Effective Treatment Must Be Free. I had a deep inner feeling that this was absolutely right...'
    Another event at Elsterhorst [where Cochrane was a WW II prisoner of war and medical officer for prisoners] had a marked effect on me. The Germans dumped a young Soviet prisoner in my ward late one night. The ward was full, so I put him in my room as he was moribund and screaming and I did not want to wake the ward. I examined him. He had obvious gross bilateral cavitation and a severe pleural rub. I thought the latter was the cause of the pain and the screaming. I had no morphia, just aspirin, which had no effect. I felt desperate. I knew very little Russian then, and there was no one in the ward who did. I finally instinctively sat down on the bed and took him in my arms, and the screaming stopped almost at once. He died peacefully in my arms a few hours later. It was not the pleurisy that caused the screaming but loneliness. It was a wonderful education about the care of the dying. I was ashamed of my misdiagnosis and kept the story secret.
     Cochrane advocated not just that effective health care be free, but that it be free for all in the NHS: comprehensive and universal. His 'deep inner feeling' is echoed in the second story: instinct, and fellow feeling, are essential if we are to discern what others (strangers dependent on the kindness of strangers, all Tennessee's bairns) need, and what and how we need to respond.
    Anyone else up for devising our own banner, and standing alongside those opposing the Health and Social Care Bill 2011?

 

Steve Tilley is an honorary fellow of the public policy network at the School of Social and Political Science at the University of Edinburgh