04.07.18
Happy birthday, NHS
The National Health Service is turning 70 tomorrow. To celebrate, Dr Michael Devlin, head of professional standards and liaison at the Medical Defence Union (MDU), looks back at some of the significant medical advances made during that time, as well as how the medico-legal landscape has changed.
1948
NHS milestone: Introduction of the National Health Service
The NHS was born on 5 July 1948. It was created on the principle that good healthcare should be accessible and available to all, regardless of socioeconomic status. Never before had hospitals, doctors, nurses, pharmacists, opticians and dentists come together under one organisation. The founding principle was clear: the health service will be available to all and financed entirely from taxation.
MDU milestone: Introduction of the Law Reform (Personal Injuries) Act 1948
The Law Reform (Personal Injuries) Act was introduced to improve the legal position of individuals who had a suffered a workplace accident. Section 2 (4) of the Act requires all personal injury defendants to disregard the availability of NHS care when paying compensation. This provision of the 1948 Act was based on the Monckton Committee report, published at a time when the NHS was being merely contemplated, and with the observation that the position might need to be “radically altered if a comprehensive health service is introduced.” The comprehensive health service was introduced, but the radical change to the law never materialised. Repealing this law would result in increased funds for all patients, including those whose need for long-term care is not due to negligence.
1954
NHS milestone: The link between smoking and cancer is established
Sir Richard Doll published research in the British Medical Journal on the impact of smoking on lung cancer, after the number of cases rose dramatically. After he studied lung cancer patients across 20 hospitals in London, Doll confirmed that smokers are far more likely than non-smokers to die of lung cancer.
1957
MDU milestone: The case of Dr Bodkin Adams
John Bodkin Adams went on trial for the murder of his patient Edith Morrell, who, following a stroke, left the doctor cash, furniture and a Rolls-Royce in her will. During her illness, Dr Bodkin Adams had treated the patient with morphine and diamorphine and, subsequently, experts disagreed during the 17-day trial as to whether this was a suitable course of treatment. The jury acquitted Dr Bodkin Adams in less than an hour. This case was significant because it established the principle of “double effect” in English law, which states that when an action has two consequences, one good and one bad, the bad consequence may be acceptable depending on the circumstances.
1961
NHS milestone: The contraceptive pill is made available for the first time
Hailed as a significant medical breakthrough of the 20th century, the contraceptive pill represses fertility with a combination of progesterone or oestrogen. It was initially only available to married women. This is changed in 1967 and, as such, revolutionised social and sexual attitudes and helped define the 1960s.
MDU milestone: Total claims payments exceeds £1m
The total amount paid out to patients by the MDU reaches over £1m. In 1961, indemnity payments and legal costs totalled to £112,293. At the time, this was the largest amount that the MDU had ever paid out in a single year.
1967
NHS milestone: The Abortion Act 1967 is introduced
The new Abortion Act made abortion legal in England, Scotland and Wales, in certain defined circumstances relating to the life or health of the mother or a substantial risk of serious handicap to the fetus.
1978
NHS milestone: World’s first test-tube baby is born
Louise Brown was born on 25 July as a result of in-vitro fertilisation. Developed by Dr Patrick Steptoe and Dr Robert Edwards, this new procedure involved successfully fertilising the egg outside the woman’s body before replacing it in the womb.
1986
NHS milestone: UK Government launches biggest public health campaign
The campaign focused on educating people about AIDS and HIV and was entitled ‘Don’t die of ignorance.’ It also used imagery such as tombstones and icebergs designed to shock and prevent the spread of the disease.
1987
MDU milestone: MDU pays out its first claim of over £1 million
The MDU becomes the first medical defence organisation to pay compensation of over £1m. This compensation was paid to a man who suffered severe brain damage following an operation to remove a cyst on the brain.
1994
NHS milestone: The NHS launches the Organ Donor Register
After a five-year campaign, the NHS Organ Donor Register was launched. The Register followed the death of Peter Cox, who, before his death in 1989, had asked that his organs be used to help others. In 2018, more than 24 million people were registered organ donors in the UK.
1998
MDU milestone: MDU introduces worldwide Good Samaritan benefit of membership
The MDU launched worldwide medical indemnity for Good Samaritan acts to members. This provided reassurance to MDU members, who knew they could lend their expert assistance in a medical emergency without facing the risk of meeting the costs of a potential future claim themselves.
2007
NHS milestone: The use of robotic technology
A new robotic arm was introduced, at St Mary’s Hospital, London, to treat patients with fast or irregular heartbeats. The arm works by inserting several fine wires into a vein in the groin, which are then guided to the heart where they deliver an electric current to the heart muscle. Cardiologists use computers and a joystick to control the robot arm.
NHS milestone: NHS Choices is launched
NHS Choices was established as the official website of the NHS in England. It aims to provide comprehensive health information and advice and, with more than 48 million visits per month, goes on to become the UK’s biggest health website, accounting for a quarter of health-related web traffic.
2009
MDU milestone: MDU issues advice on social media
The introduction of platforms such as MySpace and Bebo results in members contacting the MDU for advice on dealing with online criticism and avoiding pitfalls on social media. In 2011, the MDU launches its own Facebook and Twitter pages. The GMC first publishes guidance relating to social media in 2012.
2012
MDU milestone: The MDU pays out its largest claim to date of more than £9m
To date, the largest compensation payment made by the MDU is £9.2m. This was awarded to a patient rendered tetraplegic following spinal surgery. It is predicted that compensation payments are only set to increase as the MDU has current cases valued at over £20m each. In contrast, in 1932, the MDU paid out just over £3,000 for medical negligence claims against its members.
2016
NHS milestone: UK’s first double hand transplant is performed
The 12-hour operation, held at Leeds General Infirmary, was performed by Professor Simon Kay, who led a team of eight surgeons. It was a complete success and the patient, Chris King, described the operation as “better than a lottery win, because you feel whole again.”