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Riding the Rollercoaster of State Medicine  

The History of Medicine, Money and Politics

image 1 I have spent three years researching the book since I knew that I could not make my points without the information to back it up. And that information is truly shocking. The book covers the history of State medicine from the earliest days to the present. It compares our NHS with healthcare in other countries and it is these comparisons that amaze. Our healthcare has slumped compared with other developed nations in a way that could not have been imagined.

Read more about the background to the book here.

NICE (the National Institute of Cost-cutting Exercises) has prevented patients from receiving drugs which are available in all other Western nations. Moreover, and shockingly, they have denied other NHS treatment to patients who have decided to buy the drugs themselves.

On the wards patients are starving, ignored by nurses too busy with administrative work to stop and feed them. The hospitals are filthy and hospital-acquired infection is rife. Patients are dying in their hundreds but the Healthcare Commission has found that the managers were more concerned with meeting targets than dealing with infection.

And this independent Healthcare Commission is to be abolished by Alan Johnson and the NHS will do its own internal inquiries. But I know that if NHS staff speak out against the problems in the hospitals they are sacked. So I have finally broken cover and told the world what is going on in the NHS.

So what can be done to save the NHS?

  1. Matrons should be put in charge of hospitals as previously. This has already been suggested but if enacted they must have power as well as responsibility. This power must include the ability to sack the cleaning staff if necessary and the companies employing them.
  2. The wards should be under the control of established sisters, again with both power as well as responsibility. Cleaning the wards should be under the authority of each of the ward sisters.
  3. Clearly more cleaning staff would need to be directly employed under the sisters' control.
  4. Mixed sex wards should cease to exist. They undermine patient dignity and they also prevent patients from undergoing their own ablutions with confidence.
  5. The minimum distance between beds should be increased
  6. Beds and their linen should be cleaned/changed between patients. This seems obvious but it is surprising how many cases I have heard of in which bed linen was not changed.
  7. The number of beds should be increased and bed occupancy decreased to the old level of around 70% thus providing the slack needed for cleaning and providing spare capacity when emergencies arise.
  8. Management should be slashed since the matron would be in charge. Increasing the number of beds should also make some management tasks (bed allocation etc.) unnecessary and thus save money on management.
  9. Healthcare should be liberalised. Patients should be encouraged to pay for their own drugs as long as they are compatible with the prescribed course of treatment
  10. Healthcare workers must be permitted to speak to the press about problems with no fear of reprisal by the managers or politicians.

The History of Medicine, Money and Politics: Riding the Rollercoaster of State Medicine, by Paul Goddard (ISBN-13: 978-1-85457-050-5, 270 pages £25.00. Clinical Press Ltd.

The book can be purchased from: Bristol Books and Publishers or Gazelle Book Services


Review for the Ulster Medical Journal by Dr Barry Kelly, Deputy Editor
This work essentially represents two parts of a whole. Part one is a medical chronology and the reader is taken on an odyssey, as we chart the evolution of medicine from prehistoric times, through the ancient world, the middle ages and into our modern world. Goddard writes with impressive authority and reveals a deep love for learning, not just about medicine, but civilization. The author also invites us to consider the huge intellectual contributions of the Roman, Greek, Chinese and Islamic worlds.

Part one of the book concludes with a consideration of medicine in the Early Modern Period, the genesis of the National Health Service and that most audacious scheme, the Welfare State. Goddard reminds us how difficult it is for contemporary citizens to imagine health care prior to its inception. Interestingly, he invites comparison with the legal system “when only the rich and poor have access to the courts,” to remind us what the rest of us, with poor health, faced before 1948.

Part two charts the time course of the National Health Service, or as Professor Goddard entitles it, “The Decline of the National Health Service.” In great detail, Harold Shipman, the Bristol Cardiac Scandal and the Organ Retention investigation are all considered. Professor Goddard. A working consultant in Bristol at the time, was well placed to appreciate the misery and suffering that these events created, both within and without the medical community.

It is clear that Goddard is not a dispassionate bystander in all this. Passionate is what he is. The second section pulsates with moral outrage and righteous indignation. His other conviction is that of patient advocacy. The author feels that permeating our physicianly core is duty to our patients. Their advocacy is our responsibility.

A younger readership, reared on tall skinny lattes, MP3 players and fashion credibility, will recoil at the description of numbing on call rotas, crippling visceral fatigue and cynical fiscal exploitation. Older readers will remember, shudder and sob quietly.

It is to Professor Goddard’s great credit that he does not trade on his international reputation as a radiologist, or a pioneer of Magnetic Resonance Imaging. In fact, his specialty is rarely alluded to. Instead he is everyman’s Virgil, guiding the reader through a medical timeline.

To paraphrase Clive James, Paul Goddard’s book affirms the truism that some of us are different from the rest of us. But so are the rest of us. This book will be of great interest to many: students beginning, and practitioners enjoying or enduring their practice. It is also likely to be relevant to medical historians, as it charts one particular small step for mankind.

Dr. S. P. Cembrowicz From Amazon.co.uk - Passionate about the NHS - but the Emperor has no Trousers, 29 Aug 2008

Prof Goddard, a lifelong specialist in the NHS had to write this book after he retired - firstly to exorcise some demons that were troubling him about the system we all love and cling to but complain about, and secondly because writing this book in post would have probably led to a swift knife in the back from hospital managers and a disciplinary GMC hearing.

Personal? very. Idiosyncratic? Definitely, Flawed? Possibly, Passionate? yes - on every page his passion shines through. Professor Goddard left John Humphries speechless on last week's today programme and has made headlines this week in UK popular press. Why are there so many managers and what have they achieved? Do old people get fed in hospital?Do doctors?Is the NHS in terminal decline? Why dont consultants name badges say doctor on them any more?

Prof Goddard has been a front line witness of medicine and its politics all his working life, starting out as a night nurse and ending up as a professor.He recounts how junior doctors first got overtime payments for their 120 hour weeks, (at 30% of their hourly rate) how the Bristol Heart Inquiry has paradoxically had the opposite effect to that intended and sundry other fly-on-the-wall insights. I couldnt sleep after reading this book. See for yourself

From Tom Goodfellow’s Review in the Newsletter of the Royal College of Radiologists

“I found myself compulsively dipping into it and reading passages aloud to my wife or colleagues”

“I found his insights very revealing”

“The book is a worthy contribution to the current debate over the future


Read my article entitled "Another Great Lie"

Daily Mail Article

This website also provides some of the background as to why I have written my book on the NHS - The History of Medicine, Money and Politics. Find out more>>


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