Royal Commission on the NHS Part II

 Services to Patients

In this part of the report we discuss those aspects of the NHS which most directly affect the individual.

We start with a chapter on maintaining good health because this affects fundamentally the provision of NHS services. We then deal with priorities in the NHS, medical and nursing services in the community, pharmaceutical, chiropody, and ophthalmic services, with dentistry, with hospital services, with hospital/community relationships and, finally, the consumer’s voice in the NHS. This is perhaps the most important part of our report.

We have found it useful – and we think our readers will too – to identify four categories or gradations of care. They are:

  • the care which a healthy person will exercise for himself so that he remains healthy;
  • the self-care which the slightly ill person will exercise which may involve medication and treatment;
  • the care provided by the person’s family and by the health and personal social services outside hospital;
  • the care which can  be  provided only in  hospital  or other residential institution.

These are not wholly distinct categories and will merge into each other. A patient should be able to move easily between them as his need for care becomes greater or as he improves. Most of us spend most of our lives, if we are fortunate, in the first category; but, again, most of us at some time will need to call upon the care offered in other categories. Whatever our needs, administrative barriers should not be created which prevent our being cared for in an effective and convenient way.

There are considerable differences in the balance of hospital and community health care between the four parts of the UK and the regions within England. While this balance should so far as possible be determined locally, it is a proper function of the health departments to stimulate and support research into the effectiveness of alternative patterns of health care delivery and to propagate the findings of this research to health authorities. The balance between hospital and community care is important. So too is the determination of priorities and the ability of the public to influence them. In what follows we examine ways in which these issues are resolved at present and look forward to new approaches which may prove effective in the future.

It is clear from our evidence that whilst there is general appreciation and satisfaction with services provided by the NHS certain aspects do cause concern. For example, criticisms were made of waiting times for appointments in hospital out-patient departments; of GP deputising services and GP receptionists; of closures of pharmacies, particularly in rural areas; and of the lack of emergency dental services and confusion about dental charges. All these criticisms are dealt with in greater detail in the following chapters.