Realisation of a dream
By Francesca Solari
ST3 Trauma and Orthopaedic Surgery, Welsh Rotation
Celebrating the NHS’s 75th birthday offers time to reflect. Where did the NHS come from and what will it become? As an orthopaedic trainee from Wales, I take pride in knowing the origins of the NHS came from the Tredegar Medical Aid Society, and that their local MP and then Health Minister, Aneurin Bevan, worked to create the NHS in 1948. What we see today is a realisation of a dream: healthcare free at the point of delivery, available to everyone and based on the clinical need and not on someone’s ability to pay. No matter who you are or where you are from, you can have access to healthcare.
It can be easy for one to become cynical with the NHS as it currently is. With waiting lists, work force crises and the current strike action all adding to a negative feeling, there is an undercurrent of discontent. The COVID-19 pandemic did not help with the situation either, really precipitating the issues and making a number of them worse.
With a system many of us would describe as crumbling, we need to take stock and think about the incredible things we do. Today I was on call and I saw a number of patients; ruled out cauda equina syndrome, reduced wrist fractures, paediatric fractures, repaired nail beds in the emergency department, prepared hip fracture patients for theatre and took a flexor sheath infection to CEPOD out of hours. I take a huge amount of pride in the work I do and satisfaction in it – as I know my colleagues do also.
Thinking about the future, I can’t help but think about how we need to make changes in many of our systems to ensure the continued existence of the NHS. I talk not only about staff training, retention and recruitment, but also regarding the environmental impact of our work. We know that surgery is the biggest contributor to the carbon footprint in the NHS and that the NHS itself is one of the largest contributors in the UK. I shudder looking at the waste generated in my operating lists. Bags upon bags of waste going to an incinerator. No one surely feels comfortable with this. No one can possibly look at the huge amounts of plastic and other waste in single-use instruments.
The classic definition of sustainability is one we all know very well; meeting the needs of the current while not compromising the ability of future generations to meet their needs. When we think about the NHS, there are threats to its existence from numerous positions. As orthopaedic surgeons, we occupy one of the largest portions of the surgical workforce. We need to be at the forefront of making change within the system to ensure its survival. Its sustainability. How can we think about our carbon footprint, ethical resource acquisition, green policies? But also how can we sustain the NHS, the services we provide? Can we change policy to make our patient’s experiences better, while reducing the carbon footprint? How can we utilise quality improvement? Can we utilise virtual fracture clinics, patient-initiated follow-up, surgical hubs? What are the barriers to us using alcohol-based surgical hand preparations, and reusable gowns and drapes? What cost-saving initiatives and technological improvements can we implement? There are more questions than answers, but there is huge appetite for creating improvements in the services we provide.
It is a pleasure and a privilege to work in the NHS and to celebrate its 75th birthday. I am not so naive as to suggest there aren’t issues threatening its survival. That much is clear. But with the collective will of those who care about it, we need to find ways to sustain it. The NHS is an incredible institution, one that successive generations have fought to keep alive. It stands for something greater than just healthcare, and occupies a place in British culture and the national psyche. We cannot let the current difficulties facing it destroy it and what it stands for. We all need to think about the simple changes we can make to help sustain the NHS for future generations and give it at least another 75 years.