Andy Gray
I was privileged in July to be present in the United Kingdom at the time it celebrated 50 years of the National Health Service. That occasion gave rise to a rash of articles in the press – some looking back at how this apparent socialist miracle had come about, some measuring its present state and immediate prospects, and at least one which took a futuristic view backwards from the year 2048. Our own brave foray into an NHS could benefit from some of those insights. British politics is renowned for its candour. When addressing 500 NHS managers at a conference, the Secretary of State for Health charged that the system had failed to honour one of its founding principles – it had failed to deliver equal care to all. In the pharmacy field this is referred to as "prescribing by postcode" – what you can access depends on where you live, what the resources of your local NHS Trust look like, how well it’s managed. The founder of the NHS, Nye Bevan, had even predicted the inevitability of rationing – "We shall never have all we need. Expectations will always exceed capacity". Soon after its launch, he noted that spending was already two-thirds more than expected: "I shudder to think of the ceaseless cascade of medicine which is pouring down British throats at the present time". Sound familiar? The sting really lay in the 2048 view. Its author had a rather romantic notion of pharmacy: "… even though the 21st century chemist shop looked like a cross between NASA Control and a Manhattan cocktail bar, the white coated "chemist" behind the counter still represented the most approachable and human face of medical advice and help". He foresaw robotic surgery, involving "telecommunications over transcontinental distances" becoming so commonplace that "the presence of surgeons in the operating theatre, like the presence of airline pilots in the cockpit, became largely an exercise in public relations". Particularly in district-based services we should guard against "indirect supervision" becoming the pharmaceutical equivalent of robotic surgery, so that the district pharmacist is a real force and not a smokescreen.
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