dr david bull

NHS – Crisis or Catharsis?

In Opinion Pieces on March 20, 2012 at 4:31 pm

So the news is in. Within the last hour, after more than 1000 amendments the contraversial NHS bill has finally made its tortuous way through Parliament. A final last ditch attempt to throw it out was overturned. And now the Health and Social Care Bill will receive Royal Assent and become law.

Much has been written about the changes and what it will mean for the NHS. Some commentators believe it is the final insult, marking the death of the sexagenarian; others believe the changes are (a) not as radical as first believed  (b) well overdue and (c) essential to modernise the service. Just because the professional bodies are stamping their feet doesn’t mean the reforms will be bad. After all the BMA was strongly against the formation of the NHS in the first place!

Only time will tell who is right.

What we do know is that the service which was formed in 1948 has seen enormous change. The NHS was never set up to provide the comprehensive service it now has to . In 1948 the treatment for a heart attack was bed rest. Those that survived were nursed back to health. Those that died (some 30%) were a usual side-effect. But have a heart attack now and before you can say ‘Myocardial Infarction’, you will have numerous ECG’s, an angiogram, an angioplasty or even a CABG (Coronary Artery Bypass Graft). Then placed on medication you will be discharged home. It doesn’t take a genius to work out that whilst this has been extraordinary in terms of survival, it comes at a cost.

And there lies the problem. The NHS budget has grown exponentially. When it was launched the NHS cost 437million pounds a year. We now spend 106 billion pounds. Yes BILLION! It is the world’s largest publicly funded health service. And the NHS employs more than 1.7million people. Only the Chinese People’s Liberation Army, Walmart and Indian Railways employ more.

As a Brit in the US, I am so proud to say that the NHS offers care for everyone regardless of wealth and that the treatment is “free at the point of delivery”. It really is an extraordinary achievement. And no-where is that felt more starkly than here in America where you pay for everything. And it’s  not cheap. And that’s why there are something like 50 million Americans with no health care. A sad state of affairs for a developed country and arguably the most developed country in the World.

But having said that, the NHS isn’t all roses.

Of course there are some wonderful examples of care, but there are also far too many instances of poor if not neglectful care, shocking standards and substandard treatment. The way we treat elderly people is a case in point. Where you live also affects the treatment you get and your outcome (the so-called postcode lottery).

We also may spend billions on our healthcare but money isn’t everything. Higher spending on health care does not necessarily prolong lives. In 2008, the US spent 7,538 USD per capita (16% of GDP) whereas the UK spent just over 3,000 (9% of GDP). And yet life-expectancy in the two countries is similar. But the US data is skewed as they do not have a universal healthcare system.

So what of the reforms? Well in theory I really like the idea that the money follows the patient. In the British system, the GP acts as the “gatekeeper” and accesses services on behalf of the patient. But for far too long GPs have been seen as a rather poor relation to the grand hospital consultants who run their departments in a god-like manner. It’s not uncommon for GPs to plead with Consultants to see their patients or to be left completely in the dark as to what has happened with their patients when discharge letters fail to appear.

So it seems a good idea that the GP will now be king and decide where and who should see their flock. They are the ones closest to the patients after all. But this also means that GPs will have to raise their game. There are some wonderful GPs and some downright shockers. And then there’s the problem that actually not all doctors want to be business managers.

Here in the US, doctors are held in much higher regard and are masters of their destiny. I recently enrolled with a GP and even though there was nothing wrong with me, my initial ROUTINE medical screening included an ECG, Chest X ray and more blood tests than I have ever had in my life including tests for conditions which are as rare as hen’s teeth. I have never ever had anything like this in the UK. Come to think of it, as a 42 year old man, I really should have had some of those tests.

And that’s where we really do differ. They take preventative screening much more seriously here in the US. And that’s got to be smart. Their philosophy is that if you find it early you can treat it. An entirely appropriate sentiment. And more importantly it is much cheaper to do this than wait until some dreadful disease has taken hold of you and rendered you irritable, incontinent or  incapable.

Now that the bill has passed, the furore will of course settle down. I have a funny feeling that the changes that will be implemented won’t lead to the predicted destruction of the NHS. Above all we must ensure it doesn’t.

The NHS is an extraordinary institution and one we should be immensely proud of.

But now we need to equip it for the future, improve it and make it work for the next sixty years.

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