July 11, 2008

From Cradle to the Grave the NHS Was Launched With the Promise of Offering Care From Birth Until Death


EHERE in the place where my life started, death seems impossible. On the walls of Aberdeen's Forresterhill Hospital maternity ward, posters offer advice on breastfeeding. Mothers with bumps lie in beds or sit in wheelchairs, waiting to push babies into the world. Crying in various pitches, belted out by tiny lungs, attests to the fact that some have already been successful. Elsewhere fathers sit twitchy and unshaven. This is where, 32 years ago, I was cut from the womb, a month before my due date, and placed in an incubator with a so-so chance of survival. My brother before me had been stillborn in one of these wards, missing his chance at life, and someone decided to extract me early. A few wards away, last March, I watched my grandmother die - one faint breath, then another, then no more.

Forresterhill is one of the largest hospital complexes in Europe. Its catchment area comprises Grampian, the north of Scotland, and the Shetland Islands. I have always felt queasy walking about here and have avoided, where possible, the gaze of people suffering itches, stitches, rashes, fractures and seizures. I used to come with my father when he gave blood: as it began to loop round the tubes, I would follow the liquid with my eyes momentarily and then fall over. Later, working as a domestic in Woodend Hospital, I found myself delivering tea to the elderly, the mumbling and the infirm.

Many things can happen in the course of life but it is the bookends - birth and death - that most define our relationship with hospitals.

On entering the corridors of the high-risk antenatal unit, the temperature feels oppressive. It is geared towards the needs of expectant mothers with high blood pressure, those who have undergone organ transplants and those expecting babies with abnormalities. Mothers with gestational diabetes sit out all or part of their late pregnancies here. Jwala Krishnan spent the last trimester of her pregnancy injecting herself with insulin. "The fact that I'm terrified of needles didn't help, " she says.

"After I was diagnosed, I stayed in here for six or seven days, learning how to manage my condition and trying to bond with the needles. I started worrying whether my baby was going to be all right, whether my having diabetes would affect his future. I was in a constant state of fear until I saw him."

The boy is six days old, has no name yet, and is fine, bar temporary low blood sugar levels due to withdrawal from his mother's insulin. He kicks his legs, squeaks, and his tiny hand slaps the Tigger motif on his baby suit. A small white plastic band on his arm shows his date of birth.

Krishnan is from Kerala in the south of India, and her husband, Kumaran, from neighbouring Madras. Kumaran tells me he is still incredulous and that nobody could have prepared him for this feeling. He can't describe it but to an outsider it looks like euphoria underwritten by self assurance. Like many new fathers, he has been gripped by the photography bug and is taking endless shots of his boy. Krishnan's mother, Radha, who has flown over from India for the birth of her first grandchild, has been rendered virtually speechless with emotion. "He's changing every second, " she says. "Right in front of us . . ."

The couple met at Aberdeen's Robert Gordon University nine years ago and thereafter settled in the city. She is a forensics analyst with the police; he commutes daily to London, where he works as a scientific advisor to a pharmaceutical company. They would have moved south to be closer to Kumaran's work but, after undergoing major surgery in Aberdeen two years ago, Krishnan wanted to have her baby here. "I trusted the hospital staff after that experience and knew that everything was going to work out fine, " she says. Given that no prospective parent can remember life before the NHS in Scotland, Krishnan's views as an incomer to the UK are reassuring.

"In India, you have phenomenally expensive private healthcare, with the same level of technology as here, but the experience is completely different. The staff here are so motivated and passionate. Everybody from the cleaners who come in the morning to the girl who takes round the water. You would think it would be difficult to maintain a personal contact with absolutely every patient, but they do it with such great ease."

The couple's favourite staff member seems to be Sister Lesley Mowat, who has been assisting births in Aberdeen for nearly 40 years and may, she thinks, have looked after me as a baby. Naturally, she has lost count of the number of individuals she has brought into the world, but her enthusiasm for the task is undiminished. "It's a miracle when you think about it, " she says. "You palpate somebody's tummy and then later in the day they go for a caesarean section and a baby comes out. Was I really feeling that baby inside somebody's body? How did all of that manage to stay in there?"

Mowat has no children of her own, but still gets letters from the children and mothers she has brought together over the years. Her real love, she says, is her special care patients, such as Krishnan. "I see them all the way through their pregnancy because I go to them as a midwife advisor and, if they have to come into hospital, they come here, to my ward. And then they come back again after delivery. I've known some of the girls for many, many years, and it's so satisfying to see them with their babies."

But there is a downside. While screening for abnormalities and treatment for premature babies have improved significantly since Mowat's early years at the hospital, disasters still happen. Knowing how best to deal with a parent's emotions after the death or disability of their newborn baby is a product of experience. "You've got to be there for those women and their partners, " she says. "It might not mean that you're saying very much. Sometimes it's about just listening to them and not saying anything at all. Maybe just putting a hand on their arm."

Mowat's direct counterpart works in palliative care.

Sister Tracy Petrie oversees Roxburghe House, a facility that looks like a holiday village, a stone's throw from Foresterhill's main campus. She scored this, her dream job, eight months ago, after several years in orthopaedics. Patients range from the elderly to those as young as 16. "It's a privilege to allow patients to die with dignity and in peace, " says Petrie. "As people face their own mortality, they start to think about their whole life and we get to share much of their reminiscences. We see many people who have had their lives planned out - they're going to do this, they're going to do that - and those plans change. This job makes you appreciate what you've got."

The balancing act of her role involves giving something of herself to patients and their families without being drawn too deeply into the obvious emotional trauma.

"People are attracted to this line of work because they want to deliver a total package of care, " she says. "You're able to care for the whole person, their physical and psychological needs. That's often skipped in other areas of nursing because you don't get the chance to spend time doing the wee extras."

One of Petrie's current patients is retired GP, Dr James Finnie MD, whose medical career began in the early years of the NHS. When he refers to Roxburghe House as Stalag 14 he is joking, one suspects. From the ward in which he is dying he has views through patio doors to a well-kept garden. A bunch of grapes and a bottle of barley water sit on a table in his room in dappled sunlight.

He is propped up on a motorised bed that he says could shoot him into orbit were he to push the wrong button.

Finnie's body is in the advanced stages of cancer, a process that began with the kidney tumour that was removed four years ago. He now has malignancies in his chest and abdomen. Like Krishnan's unnamed baby, he wears a white plastic bracelet on his wrist - his date of birth is written as 22.07.25.

AS a young man, Finnie built his general practice in Aberdeen's Tory and Ferryhill districts with his lifelong business partner, Gordon Rhind, who he says he would trust - and occasionally has trusted - with his life. "Life is built on partnerships, " he says. "You want to marry the right girl. You also want to join as a partner a guy who you could rely on for everything." Finnie became a GP after watching a public lecture by another doctor when he was a teenager. He struck out on his own after a spell in the navy, where he treated sailors for venereal diseases, and his hopes and ambitions were high. "I brought modern medicine to the practice, " he says. "I'm not denigrating anybody, but the old guys who were running the practice before us weren't safe to have around. One was a great motor enthusiast and knew more about cars than the human body." He believes his was the first GP practice in Scotland to introduce an appointments system, pioneering the use of electrocardiograms and other nascent technology. "I think we practised a very high standard of medicine, " he says. "Lots of people would have been regarded as more intelligent than us in terms of diagnosis, but there's more to medicine than diagnosis. You want to be able to establish a bond between yourself and the patient in which each person trusts the other." As a sideline, he worked as a medical advisor for several Aberdeen employers, with a brief "not to prevent professional advancement" but to identify "the kind of people employers wouldn't want to be landed with. If you saw a chap who had advanced cancer like I have, you wouldn't want to employ him."

In the 23 years since he retired, medicine has changed considerably and so has he.

Finnie struggles to remember names of fairly common conditions, and says he knows nothing about current medical practice. But he knows too much about his own illness to be able to plead blissful ignorance. "It probably makes it worse to know yourself what's going on, " he says. "I've known for a number of years about my condition." He is a "lame duck", he says; having recently injured his back, he can't move without physical assistance. While recuperating, he is taking advice as to what can be done about his cancer. "I'm bouncing along as the ball goes, just to see what happens, " he says.

"I always thought I'd like to be hit by a corporation bus doing 45 miles an hour down Hilton Road. I would like my death to be quick. Sadly, it isn't going to be quick.

But if you didn't remain marginally optimistic you would probably go and hang yourself."

Such thoughts, he admits, have crossed his mind.

"There are numerous ways, if one could deal with it, that would put an end to things relatively quickly. People say it's a coward's way out but I don't think it's a coward's way out at all." The straight face with which he talks about his predicament begins to crumble when he mentions his wife, Ishbell, the mother of his two sons.

THE pair met at Aberdeen Students' Union 65 years ago, when both were 18. She worked as a PT teacher and could have swum for Scotland, in Finnie's opinion, had the second world war not been in the way. "My life revolved around Ishbell, " he says. He paints a picture of his wife in her physical prime, so different to the person she has become. For the past two years, she has been resident at Aberdeen's Royal Cornhill Hospital suffering from Alzheimer's disease. "I visit Ishbell every three to four weeks, " says Finnie. "It's extremely tough because most of the time she has no earthly idea who I am. She doesn't recognise any of the family and for the last three years I've been almost praying that she would be wiped out with some short, sharp, overwhelming illness, but it's never happened."

He rubs his eyes, looks away. As a man who has spent a lifetime trying to cure ailments, his next statement comes as something of a surprise: the ultimate cruelty, perhaps, through his desire to be ultimately kind. "I'm filled with admiration for the occasional man I see who has taken it upon himself to asphyxiate his wife with a pillow, " he says.

"But I wouldn't like to commit Ishbell to that."

The thought that he will probably die without being able to talk things through with Ishbell clearly troubles Finnie. Shortly before arriving at Roxburghe House two weeks ago, he visited her speculatively at Cornhill. "I thought I would just go and see her to say goodbye, " he says. "And by God, she recognised me. She said, 'Jimmy, it's you darling, give me a kiss.' I don't know that she definitely recognised me, but you would think . . . that's what we always said."

He waves a hand in front of his face and falls silent. As I sit watching him, a memory floods back from my time as a domestic at Woodend Hospital. The bedside tables of the wrinkled, sometimes terminally ill patients often held photographs of their younger, more appealing, selves - at a time when their teeth weren't kept in jars by the bed, and being spoon-fed would have seemed ridiculous. Tired during those early morning shifts, I remember the moment the penny finally dropped: that if I were to climb into one of the empty beds and sleep long enough I would wake up just like one of those people.

But for now, I am 32 years old and healthy, and about to make another visit to the maternity ward where my life began. Before I go, Dr Finnie wants to shake my hand. "I've bared my soul, and I've enjoyed myself, " he says, "but that's it."

How the NHS transformed public health

1948: The NHS is launched by health minister Aneurin Bevan giving, for the first time, every citizen access to free health care. In Scotland, where the Highlands and Islands Medical Service had been a forerunner of the new service, the NHS is established by a separate act of parliament.

1952: Prescription charges are introduced - at one shilling, or 5p.

1958: Ultrasound scans are pioneered at Glasgow Royal Maternity Hospital.

1958: Vaccination programmes, below, are introduced to protect everyone under the age of 15 against polio and diphtheria.

1960: A kidney transplant, carried out at Edinburgh Royal Infi rmary, is the first such successful operation in the UK.

1961: The contraceptive pill is made available to married women. By 1969, around a million women are "on the pill".

1963: The world's first chair of General Practice is created at Edinburgh University, reflecting the centrality of GPs to the success of the NHS.

1968: The Abortion Act makes the termination of a pregnancy legal up to 28 weeks, lowered in 1990 to 24 weeks.

1968: Britain's first heart transplant is carried out at the National Heart Hospital in London. Although of limited success, the pioneering procedure paves the way for heart transplant operations that extend the lives of patients for many years.

1972: The NHS Scotland Act reorganises the service to make it more efficient, establishing 15 regional health boards.

1974: Family planning services are introduced The new measure formalises contraceptive advice for all, irrespective of marital status.

1978: The first test-tube baby, Louise Brown, is born. The technique, in vitro fertilisation, allows an egg to be fertilised outside the woman's body before being replaced in the womb.

1980: MRI, or magnetic resonance imaging, is introduced at Aberdeen Royal Infi rmary.

1986: The biggest public health campaign ever is launched against HIV and Aids, after the disease claims several high-profi le victims.

1988: Fife-born Sir James Black, who discovered drugs to combat heart disease and stomach ulcers, is awarded the Nobel prize.

1988: Breast cancer screening is introduced after recommendations by Sir Patrick Forrest, professor of surgery at the University of Edinburgh.

1989: The "internal market" is set up, introducing market competition for services into the NHS and the idea of patients as "consumers".

1989: Keyhole surgery, allowing surgeons to operate speedily through a small aperture with the aid of a tiny camera scope and a TV screen, is undertaken successfully for the first time. The procedure is carried out at Dundee's Ninewells Hospital.

1992: The Private Finance Initiative, or PFI, is introduced, allowing private firms to build and maintain NHS hospitals.

1993: Care In The Community policy introduced to shift focus of care for mentally ill people and those with learning disabilities away from institutions and towards the principle of supporting them in their own home and community.

2006: A ban on smoking in public places is introduced by the Scottish parliament, ahead of the rest of the UK.

2007: A robotic arm, controlled using a computer, is introduced to treat patients with irregular heartbeats.

2008: Mutual NHS government action plan introduced. After the privatisation of the 1990s shifted the designation of people using the NHS from patients to consumers, Mutual NHS sees the people as "owners" of the NHS - with both rights and responsibilities for improving their own health.

Originally published by Newsquest Media Group.

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