Columnist Dr Copperfield says we need to stop peddling the myth that prevention is always better than cure and accept that people will still get sick
If you want to have a big think about the current state of the NHS – and I appreciate you don’t, you just want a holiday, but bear with me – then go to your local A&E, either as a patient or a relative. I’ve recently done both and believe me, it’ll give you plenty of food for thought. And plenty of time to think about it.
First was with my elderly dad, who’d had a fall. It’s a cliché to describe A&E as a war zone, but, honestly, it was a war zone. Ill patients on trolleys in every conceivable space, with barely any room for the clinical staff to move. I genuinely thought that there might have been some major incident. When I queried this with the sister, she just shrugged and said, ‘This is quiet – you should see it in winter.’ Er, no thanks.
Second was my own urgent attendance at a local DGH. Utterly rammed, and a six-hour wait for assessment. Big deal? Well, yes, I think so, given that it was 2am on a Wednesday in mid-summer. When I used to work in A&E, I’d normally expect a couple of hours kip on a midweek night shift. The staff here looked like they’d never slept, and had an air of grim resignation, maybe because they were thinking of resigning.
So I spent my many waiting hours – sat on the floor, as there were no seats available – mulling over the NHS. And I made a resolution that the next person I hear saying, ‘What we need is a National Health Service rather than a National Illness one’, I will punch in the face, even if that means they’re bumped above me in the casualty queue.
This mantra is trotted out during every NHS debate or reorganisation, and I’m sick of it because it’s wrong. The concept of ‘health for all’, aka ‘preventing illness in the first place’, was one of the fundamentals of the NHS’s inception, 75 years ago. And we should realise by now that, with one or two exceptions (off the top of my head: immunisations), it doesn’t work. Focusing on prevention doesn’t stop illness or death, it simply delays it. Obvious, really.
Yet we continue to peddle this myth, kidding ourselves that all the pressure on the frontline would be relieved if only we screened more/diagnosed earlier/statinised more widely etc. Well, those frontlines are A&E and general practice: I’ve painted a picture of what the former is like, and you know all about the latter. It’s not working. That frontline is so routinely overwhelmed that the ensuing chaos and dysfunction is becoming dangerously normalised.
So how about we properly fund those services by diverting some of the absurd amounts we spend on preventive initiatives of marginal benefit? How about accepting that people will still get sick and distressed and need urgent care? How about, in fact, a National Illness Service? Because, at the moment, we don’t even have that.
Dr Copperfield is a GP in Essex. Read more of his blogs here