Plus ça change, plus c'est la même chose.

68 years ago, shortly after I was born, the world did not look too dissimilar to today.

Europe was full of displaced foreigners, many living in barely sanitary camps, fighting a daily battle for survival.

Britain, in particular, had received large numbers of these 'foreigners' who were viewed with great suspicion. They were seen as taking away the jobs of returning servicemen; of being a burden on the state; the children as 'swamping local schools'.

There was a shortage of Doctors and Nurses, hospitals were under resourced; the war years had left a nation bedevilled by disease, ignorance and squalor.

We even had the requisite hate media figures - instead of Lord and Lady Green, we had Lord and Lady Docker with their gold plated Daimlers with zebra skin interiors, swanning around Monaco.

Surprisingly, given that many of my generation believe that we fought the war against the Nazi's because of the horrors of the Holocaust - there was a lively seam of anti-semitism that survives to this day. The Jewish community guaranteed that it would bear all the expenses, of accommodation and maintenance, of Jewish immigration, with no burden placed on the public purse. The publicity given to the Kindertransport served to mask the fact that cabinet minutes of 1945 claimed that 'the admission of a further batch of refugees, many of whom would be Jews, might provoke strong reactions from certain sections of public opinion'. 

We might care to remember that the first Immigration controls in the UK were put in place under the Aliens Act in 1905 - to control Jewish immigration. Just as in the early part of the last century, when it was Jews who were seen as the foreign pestilence, taking up the jobs of 'decent' Englishmen, using up precious resources that rightfully belonged to those who 'already lived here' or at least, had 'arrived a decent interval earlier' so today we are consumed with the pressure on resources of different refugees and asylum seekers. 

The Second World War had introduced one important change - the large number of civilian casualties had brought into people's lives the notion of 'the government' treating their health problems. Before that, you only saw a Doctor or Nurse if you had the money to pay for one. Most working people simply didn't. Rationing also played a part - suddenly everyone was eating more or less the same food - and government ministers noticed that the health of the poor had improved as a result.

There was still a whiff of the 'Dunkirk spirit' in the air, even amongst politicians. A sense of the whole country pulling together for the good of the people.

It was in this atmosphere that the Beveridge Report of 1943 came to be written; it identified the 5 main evils facing a post war Britain. Squalor, ignorance, want, idleness, and disease. Thus was born the Welfare State. With the best of intentions. Disease, in particular, was to be tackled by the newly minted 'National Health Service'.  

One of the guiding principles of the Beveridge report was that:

'A revolutionary moment in the world's history is a time for revolutions, not for patching'.

Now, nearly 70 years later, The National Health Service (and indeed the Welfare State, but let us just stick to the NHS for now) is in desperate need of a rethink. 

A revolution, not just 'another patch'. 

The National Health Service as envisaged in 1948 was a 'sickness' rather than a 'health' service. It was intended to do away with the fear of not being able to pay the Doctor when sickness entered a household. It coincided with advances in medicine and technology and drugs - penicillin, TB vaccination and treatment, drugs for mental health and blood transfusions. Infant mortality in particular, went down rapidly surprisingly so, for women were generally afraid of hospital births - in the past they had signified major complications and rarely ended well.  

However, the end of the war years also saw a period of great optimism about health, and a marked change from 'infectious and epidemic' to 'chronic disease' and the 'diseases of affluence'.

In the early years, the NHS was said to be financially profligate as the poor rushed to acquire new teeth and spectacles...The fledgling NHS had budgeted £1million for opticians, but within a year 5.25 million spectacle prescriptions (and other work) had produced a bill totalling £32 million! Commentators at the time spoke of the 'feckless poor rushing in to strip the chemist shops of every pill on the shelves, then heading for the dentists' surgeries to have their mouths filled with gold and silver...'

Has that happened? 

In a sense, yes. Though why confine ourselves to the feckless poor? Every class of person has raided the NHS 'shop' for every imaginable illness. People live longer. They survive serious accidents in a way that our '1948 NHS' couldn't have imagined. The demand services that were unheard of in 1948. 

At the same time, we demand that the NHS behave as though it was a 'product'. A commodity that must come up to our expectations. It is not enough that it cures our sickness. It must do it in a 'timely' manner'. It must have a 100% success rate. 

If it doesn't, we expect to sue it for failing to meet their high expectations. 

One man was involved in an assault. He arrived at an A&E department at 8.26pm in the evening. He left again at 8.45 not having seen a nurse or Doctor. 19 whole minutes he had waited. An hour later he was returned to the hospital by ambulance. Sadly he had suffered damage in the assault and has been left permanently disabled. There is no doubt that had he remained at the hospital he would not have suffered such permanent damage. 

He sued the hospital 'because the receptionist was 'off-hand' and informed him that he would have to wait four or five hours'.

Admittedly, the relevant guidelines in force stated that those with head injuries should be reviewed by a trained person within 15 minutes - and his 19 minute wait had already exceeded that. Did he know that? I doubt it.  The other main basis of his claim was that A&E receptionists owed a duty of care to give 'accurate information' as to waiting times.  As it happens, the judge decided that he was not prepared to find that breaching that NICE guideline amounted to negligence.

Needless to say, that will not be the end of the matter. His lawyers have already announced that they are planning to take the matter to the Court of Appeal - and who knows, maybe right up to the Supreme court?

I give you that case to illustrate just what we expect from our NHS today. How far we have come from the idea of curing sickness - to expecting a top-notch receptionist who gives us accurate waiting times.

The end result is that of the £120 Billion pounds that we put into the front door of the NHS this year - £56 Billion pounds will be going out of the back door to lawyers and their clients.

Possibly even to the impatient patients.

The NHS needs a revolution, not just 'another patch'.