The NHS at 60

The past sixty years since the inception of the NHS have seen many developments in how health is delivered. Where patients are treated and recover; the conditions that are considered illness and the techniques doctors have available to deal with disease have all undergone dramatic changes since 1948.

This exhibition explores some of the major advances in surgery that have occurred since the start of the NHS and how patients have benefited.

Professor Harold Ellis

Professor Ellis qualified in 1948 the month the NHS was born. We are grateful to him for the ‘early days’ images shown on the left.

Surgical Oncology

Surgery remains by some way the most effective curative treatment for cancer. As more people survive cancer new techniques have improved the quality of life for patients.

It is well known that breast cancer can often spread to the lymph nodes under the armpit. In the past, screening involved making a large incision and removing up to 20 lymph nodes to check the cancer had not spread – this was invasive and risked causing further future health problems by damaging the immune system.

The sentinel lymph node (SLN) technique works by placing a radioactive tracer dye into the breast. Surgeons use a probe picks up a signal as the tracer moves through the armpit to the lymph nodes. The sentinel lymph node (SLN) is the first node that a tumour is likely to spread to and the radioactivity will be strongest there. This way the surgeon identifies which lymph glands have the strongest signal should be removed for testing. This is a much smaller and speedier operation removing just two or three nodes and is much more comfortable for the patient with less long-term health consequences.

Fiona MacNeill
Breast Surgeon
Royal Marsden Hospital

Cardiac surgery

At the start of the NHS there was very little a surgeon could do for heart conditions. The issue was time – no patient could survive for more than a few minutes without a working blood supply and surgeons did what they could working around and in a beating heart.

Dealing with bullet and shrapnel injuries to the heart during the war had given surgeons greater experience of working with the heart.

Surgeons learnt that cooling the body extends the time a patient can survive without blood supply before they suffer brain damage. Cooling to 30C offered a short four minute window to stop the heart and close defects – so surgeons had to be extremely skilled under pressure and only a limited range of conditions could be treated.

In the fifties, the development of artificial circulation machines in the UK and US allowed the heart to be stopped and blood could be oxygenated and pumped separately. This meant longer operations were possible and led to developments like heart bypass and transplant.

Professor John Wallwork
Cardiac surgeon
Papworth Hospital

Day Surgery

In 1948 a relatively simple operation like hernia repair would have meant an average hospital stay of two weeks. Not only was the surgical technique more rudimentary, but the attitude to post-operative care emphasized bed rest. Later it was noticed that patient’s were developing blood clots and dying due to being recumbent in bed and realised that mobilization was good for recovery.

In the seventies, the emphasis started to change to enabling patients to recover in the comfort of their own homes. Technological improvements such as more subtle anaesthetics and minimally-invasive techniques have enabled more and more operations to be handled on this basis. From a handful of such operations in the early 1980s, over 170 procedures can be undertaken as a day or short-stay case.

Mr Doug McWhinnie
General Surgeon
Milton Keynes General

Orthopaedic surgery

Since the invention in the 1960s, joint replacement has given a new lease of life to patients suffering from the agonising pain and lack of mobility caused by severe arthritis. The idea was largely pioneered by NHS surgeons and has gone on to be one of the most common and successful operations carried out across the world.

Sir John Charnley’s invention of the artificial hip in the early 1960s paved the way for further innovations in replacement knees and shoulders.

Mr John Getty
Orthopaedic surgeon
Northern Hospital, Sheffield

Paediatric Surgery

Operating on infants and children requires special care and, since the mid-twentieth century, novel techniques have been developed that have enabled more conditions ever younger patients to be successfully treated.

By the mid-1970s a whole range of life-threatening congenital conditions could be successfully treated, even in prematurely born infants. One example of the astonishing progress that has been made is in surgery for Oesophageal Atresia – a condition where children are born with a blind-ended oesophagus which does not connect to the stomach. Survival rates for this condition have gone from zero per cent at the beginning of the NHS to ninety per cent now.

Mr David Jones
Paediatric Orthopaedic Surgeon
Great Ormond Street Hospital

Reconstructive Surgery

At the birth of the NHS much progress had been made in reconstructive surgery due to experience built on treating battle casualties during world war two. But plastic surgery could only use skin and muscle adjacent to the area being treated. By proving that you could take material from any area of the body and connect into local blood vessels, the development of microsurgery has had a dramatic influence on the range of reconstructive surgery.

NHS consultants were among the world-leaders in microsurgery, with the first toe-to-thumb transplant achieved in East Grinstead in the late sixties. We can now reattach body parts, repair much larger defects and reconstruct lost function as well as appearance.

This has had important knock on effects in the support of work by other surgeons, especially those treating cancer. Oncology surgeons can now remove much larger tumours that would have been considered inoperable in the past, in the confidence that microsurgery techniques mean the wounds left can be reconstructed.

Professor Simon Kay
Reconstructive Surgeon
Leeds Royal Infirmary

Urology

The idea of looking inside the body using a tube inserted through a small incision has been around since the time of Hippocrates, but it was the innovations of Harold Hopkins that transformed it into an invaluable surgical technique.

Shortly after the creation of the NHS, Hopkins invented the rod lens system – a massively improved version of the conventional telescope used for looking inside the body. Soon afterwards he invented the fibre optic cable, which allowed high intensity “cold” light to be projected into body cavities from an external light source. Previously, doctors had used tiny halogen bulbs on the end of the telescopes, which were relatively dim and carried a risk of burning the patient.

Initially used mainly in Urology, Hopkins’ devices were soon adopted by other specialties, creating a whole new branch of surgery. “Keyhole” or “minimally invasive” surgery allows surgeons to perform diagnoses and complex procedures with minimal risk and trauma to the patient. Its impact has been so dramatic that today many surgeons rank the rod lens system and fibre optic light source as the most important medical developments of the 20th century.

Mr Derek Fawcett
Urological Surgeon
Royal Berkshire Hospital