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Legal aspects of Cultural, Religious and Ethnic Changes in the NHS-UK from 1964 to 2019

Medico Legal

by Dr Bashir Qureshi

FRCGP, FRCPCH, AFOM-RCP, Hon FFSRH-RCOG, Hon FRSPH, Hon MAPHA-USA.

• Expert Witness Cultural, Religious & Ethnic issues in Litigation.

• Expert Witness in GP Clinical Negligence.

• Author, Transcultural Medicine; dealing with patients from different Cultures

Introduction: NHS Formation

Politics

Politics, Economics and Law are as essential for patient care in the National Health Service (NHS) in the UK as Medicine. The NHS, was started on 5th July 1948 by the then Minister of Health in Attlee’s post 2nd world war Labour government, Aneurin Bevan, at the Park Hospital in Manchester. Happy 71st Birthday on 5 July 2019! The aim has been to provide a good, multi-professional and reliable healthcare free for all British citizens. In addition, there were privately paid services available for the rich, in NHS hospitals and in Private hospitals. This aim has not changed but delivery of most services is changing all the time.

Finances

After the 2nd world war, Germany and Japan lost their treasury assets. Britain shared this wealth with France, USA and Russia (USSR). On 15 August 1947, Britain withdrew from India and then from other colonies. The treasury assets from these countries were transferred safely to the Bank of England and later it was called “Common Wealth”. The government made sure that this wealth be spent on Public Services including the NHS. Another long-term income for the NHS, has been an NHS tax from salaried and self-employed workers.

Some services such as dentistry are subsidized, half paid by NHS funds and the rest by the patients. Some patients, elderly and disabled, get free care and prescriptions. Most immigrants are charged full cost of NHS services. Now 71 years on, that wealth has been wisely spent. Therefore, in good faith, it is essential to reduce costs for NHS services.

Cultural Aspects

Manpower

In 1960’s, I witnessed that the vast majority of patients were White British, mostly men, who were war wounded or traumatised by deaths of their soldier relatives or colleagues. There were Geriatric wards and Disables’ wards in addition to General Medical and Surgical wards, in all hospitals. Some diabetic type 1 patients used to sleep in hospitals to get treatments and go to work in day time. There were many mental hospitals where patients worked to produce goods for sales outside.

As two million British soldiers died in World War II, along with four million German and six million male Jews, there was shortage of male factory workers and male doctors and staff for the NHS. Nurses were recruited mainly from Ireland. British Labour Government negotiated, as one-off agreement, to import 40,000 factory workers and 18,000 doctors mainly from India, Pakistan and Sri Lanka. They had to be men aged 20 to 40 years and in good health.

Doctors were trained by British qualified and supervised Professors. Two English Appraisers used to visit every year to check the authorized Medical Colleges abroad. I am one of those 18000 doctors, who were given “Acquired Right to Practice in the UK” without having to pass any medical examination in the UK. However, I am unusual. I passed three basic English qualifying examinations and 17 English Medical Diplomas, Memberships and Fellowships of British Royal Colleges or Academic institutions. My website is worth reading, I hope. Foreign Doctors in the UK, were retrained and supervised by many English or Scottish consultants and senior doctors to make patient care very safe. Now in 2019, the NHS staff is Multicultural, Multireligious and Multiethnic, mostly UK trained and Appraised.

Complaints

In 1960’s, every patient had his or her named doctor GP whom they saw as needed. Relationship between patient and doctor, in GP surgery and in hospital clinics, was strong. Patients took their doctor’s advice readily. If there was any concern, the patient contacted verbally a Practice Manager or hospital Nursing Sister. If a patient died, sometimes the doctor was invited to attend the funeral. If a patient felt upset and left GP surgery, the GP lost his/her fee from NHS money.

Now, in 2019, patients are made to see any doctor on duty and not necessarily their named doctor. This is to protect a doctor from patient’s complaints. No “named doctor passes” are issued anymore. Increasingly, patients tend to complain and seek monitory compensation for their complaints. The work and income of Judges, lawyers,expert witnesses and witnesses had increased. Every doctor has to have expensive Insurances to pay for claimants’ claims. A patient complaint can bring punishment from the General Medical Council as well and some of them may lose registration to practice medicine in the UK, even forever. Due to such a stress of patients’ complaints, some doctors have committed suicides or developed depression. These pressures and NHS costs cuts have reduced the number of doctors, resulting in more pressure on those who are still working. I work as an Expert Witness in GP Clinical Negligence and witness it.

Religious Changes

Religious Influence

In 1960’s, some NHS and private hospitals were run by Christian organisations and Irish Blue Nuns (wearing blue head scarfs) in the UK. Majority of hospitals were run by liberal or secular Christians. In 1965, I worked as a House Physician/Medical Officer at St Andrews Hospital, Dollis Hill, London. It had a sister hospital at St. Johns Wood. Administrators and senior nurses were Blue nuns but medical staff and patients were mostly English and other Europeans. In other hospitals, nurses were recruited mainly from England and Ireland. In St Andrews Hospital there were 40 NHS beds and 80 private beds; I was one of two House Medical Officers but there were 5 English consultants. With time, these hospitals and many local hospitals have been closed. In 2019, I witness that in many hospitals in London the doctors, nurses and healthcare staff are becoming multicultural, multireligious and multiethnic. Any patient who asks to be cared by a white British staff is disciplined.

Religious respect

In 1960’s, there were mainly Christian doctors, nurses, staff and patients; therefore, only Christian festivals were celebrated in hospitals. As a resident house Medical officer, I used to enjoy Christmas; when I used to push a trolley full of wines and whiskies, an Irish ward sister used to greet a patient and a male English or Scottish Consultant used to pour a drink even to someone who had alcoholic cirrhosis. Now in 2019, patients and staff are from many religions the religious ceremonies of various religions are celebrated in Religious room on ground floor of many hospitals. Everything changes with time except this principle (Aristotle). I work as an Expert Witness in Cultural, Religious & Ethnic Issues in Litigation. When I gave evidence in a Criminal Courts, the press was present but not allowed to report, by judge, so as to avoid public reaction to my impartial opinions.

Ethnic Factors

Hierarchy

Every country has the same tradition in hierarchy in every job, being other factors equal, that the first job would go to a candidate from the race or ethnicity of the majority of the country. For example; in England, 1st job would go to English, 2nd to Scottish, 3rd to Welsh, 4th to Irish, 5th to European, 6th to any other from a white country e.g. Australia, 8th to Asian, 9th to Afro-Caribbean, 10th to African and so on. Interestingly, this fact applies to the post of the Prime Minister or President in every country. It pays to accept reality and proceed forward. Positive approach would achieve more than a negative response.

Preferences

It is a natural human instinct in Preferences or discrimination, to consider mainly six major factors:

1. Age

2. Gender

3. Social class

4. Culture

5. Religion

6. Race/ Ethnicity.

No one can eliminate these instincts but everyone has to accept or reject these factors. One has to negotiate how and to what extent to get around to survive and thrive. The NHS is a great tradition and asset of British nation. I hope it continues for many years. This article is written on 5 July 2019, at 71st Anniversary of the NHS, in my role as an Impartial Expert Witness in Cultural, Religious & Ethnic issues in Litigation since 1992.

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