Dr Tony Copperfield feels his faith in the NHS slipping and warns that only a radical reset can restore it – starting with an admission that people don’t live forever
Confession: I’m an atheist. A quietly sceptical one rather than the rabid, evangelical, all believers are mad/morons version. I don’t want to burn all my bridges, right?
What I have always fervently believed in, though, is the NHS. It’s that omnipresent, benevolent entity that you can rely on for cure or comfort from cradle to grave. It was there for me when I was a wheezy toddler, it safely delivered my two babies and it dealt swiftly with my son’s appendicitis.
So I have faith in the NHS. Not least because I’ve devoutly dedicated my working life to it, assuming that, when my infarct strikes, I’ll be ushered through the pearly entrance gates of A&E where medical angels will mop my sweaty brow with one hand and thrombolyse me with the other.
My belief can only be restored by a complete NHS reset. Which is timely: as this month’s cover suggests, revolution is in the air. And if we’re going to radically alter our contract, why not go the whole hog and transform the health service?
This emphatically does not mean the usual clichés of ‘working smarter’ or grovelling for random pots of funding. No. It’s time for extreme measures. Starting with the fundamental but tricksy question of, actually, what is medicine for? Then, assuming we can get close to an answer, defining what our NHS can reasonably be expected to deliver.
If the movers, shakers and policymakers are stuck for a response, I’d like to suggest this: we rebadge and reorientate the NHS as the ‘National Illness Service’. One of the ideas behind the NHS’s inception was that emphasising ‘health’, aka ‘prevention’, would reduce illness and thereby contain costs. We now know this to be spectacularly wrong. Prevention as we know it – with notable exceptions like immunisations – simply turns people into patients.
The benefits are marginal and the costs huge. We spend so much time, effort and money chasing the dream of making people live forever, only for them to develop other illnesses and care needs, that we no longer have the capacity to treat the sick.
So let’s radically reset NNT, QALY et al thresholds for all those preventive activities, accept that people do get ill and channel the released funds into looking after them properly when they do.
Give patients a say, of course. But ask them in terms they’d understand: ‘When you break your hip, would you be happy to accept a relative taking you to hospital strapped to a plank because there are no ambulances available, if that means another patient can take a statin for 10 years to prevent a heart attack or stroke that probably wouldn’t have happened anyway?’
I think the public would prefer a functioning NIS to a non-functioning NHS. The alternative, for me personally, is to convert to the dark side of private medicine, because I no longer have faith in the NHS saving me – assuming I could afford the premiums, and survive hell and damnation.
Does anyone have the vision, the political will and the balls/ovaries to make this transformation?
God only knows.
Dr Copperfield is a GP in Essex. Read more of his blogs here