As a registrar and a parent I learnt how to frame questions. Instead of asking my daughter if she wants to go for a nap, I ask her, ‘Do you want Mummy or Daddy to put you down for a nap?’ The assumption is made already by the framing of the question that she is going for a nap.
What I should be asking my patients who still smoke is, ‘How do you think you can best give up smoking?’, instead of, ‘Do you want to give up smoking?’
But it’s not just parents and doctors that use framing of questions to help achieve their aims. NHS England has recently done it too.
Before the election, press reports focused on whether political parties would pledge to fund the predicted £8 billion shortfall expected in the NHS by 2020. The framing of the question offered over this shortfall, posed by NHS England in the Five Year Forward plan, was that there will be this amount of money to be made up once efficiency savings of 2-3% have been made between now and 2020. That is a saving of £22 billion, according to them.
The NHS will have to find efficiencies and cut the amount of expenditure for the first time in its lifetime, at a time when the population is getting older, frailer, with more complex health problems. At a time when emergency admissions are on the increase and frail, complex elderly patients get stuck in acute beds due to lack of social care capacity. At a time when drug companies can threaten to sue if branded versions of their drug are not prescribed, instead of cheaper generic forms. At a time when demand for GP consultations is rising, the new government have pledged to increase the primary care doctor workforce by 5,000, providing a seven-day service and guaranteed quick access for over-75s.
At a time when the Commonwealth Fund has ranked the NHS as being the best value for money health service, it is being asked to do more and become even more efficient.
To me it simply doesn’t add up. I’m aware, despite its rating, that an organisation as big as the NHS is probably, even likely, to be inefficient, but I’m not sure that the savings sought will be easily found. All the pressures on the NHS seem set to inflate costs, not cut them.
The only conclusion I can reach is that at some point there will be a crunch and – forgetting the £8 billion shortfall – there will be a counting of the pennies.
If the £22 billion is not saved, or being saved, then something will have to give. Nurses? Doctors? Hospitals? Drugs? Socialised healthcare itself?
Dr Samir Dawlatly is a former secretary of the RCGP’s adolescent health group and a GP in Birmingham.