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.
But now I’ve lost my religion. Because the ambulances aren’t turning up. The antibiotics are running out. And the waiting lists are endless. The NHS has finally tipped from saviour to sham.
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
“Does anyone have the vision, the political will and the balls/ovaries to make this transformation? ”
that’s an easy question!!
………..No… 🙄
Spot on, as always!
Add in sorting out the litigation garbage and a fee up front, possibly reimbursable for some, and you might have a chance!
And not forgetting, have people like you in charge, ones who actually know what they are talking about!!
Perhaps, given the evident failing NHS and poor performance on hard outcomes compared to other wealthy countries (OECD), the answer is a ‘freemium’ NHS.
If you are ill your tariff for your illness stays with you but you are free to top up, either with traditional NHS providers or with third party providers. Top up could be to ensure a more rapid clinic date, or for convenience, or to select a named clinician or mode of consulting. Top ups would be set at the market rate.
During an admission top up would pay for a private room, or a wider food selection.
This would naturally start differentiating what patients value at a given time, and draw resources into the service whilst providing more of that service.
This might be on a pay as you go basis or people might naturally start paying insurance premiums for this top up portion of their care.
This would help all patients, not just those who pay, as there would be incentives to over provide the beds and facilities, not constantly cut capacity.
The airline industry, often a poor comparator to healthy given their planes can simply not fly if old, leaky, understaffed and overloaded, does show some insights here. Post Covid the amount of business travel has plummeted. As business travel used to be a high margin option it reduced the cost for economy seats for long distance travel. Now business travelers are no longer ‘topping up’ for the same journey with more comfort the cost and options for economy flights have worsened.
The possibility of people paying for convenience and comfort whilst all receiving healthcare should not be feared – rather it should be an option to see if it improves care for all.
They could charge patients if they fail to log in online before arriving at A&E, arrive with more than a toothbrush or want to take a pee like on some airlines.
50% of the population take more than they contribute to the state. They will be unable to or unwilling to pay for healthcare. A sufficient proportion to make such a decision poisonous to the electorate. Hence, the country will remain in the state of self-delusion that it can be fixed with the medicine that has poisoned it.
1. Public accept less from cradle to grave
Or
2. Further downgrading of the profession with further decades of sub-inflation pay rises and pay restraint through ‘reduced’ hours work
Or
3. NHS becomes so bad that more of the middle classes start to use private health insurance like in the USA. OK until we have those unable to secure insurance / maintain employment as in the USA ie the safety net fails in other ways
Does anyone have the vision, the political will and the balls/ovaries to make this transformation?
– There has and always has been, only 1 answer: only the public can.
“I do not believe that the solution to our problem is simply to elect the right people. The important thing is to establish a political climate of opinion which will make it politically profitable for the wrong people to do the right thing. Unless it is politically profitable for the wrong people to do the right thing, the right people will not do the right thing either, or it they try, they will shortly be out of office.”
― Milton Friedman
Unfortunately, the transformation has to go deeper than simply the NHS. The NHS is but 1 component of the “welfare state”. If you don’t stop “incentivising illness”, “legal aid in medical litigation”, etc, little will change.
Fee up front, co-payments, etc, are all sticking plasters.
Fundamentally, what needs to change to is the idea that taxpayers would only be happy to fund certain “primary” things for others, and for all else, we as individuals, pay for what we need individually.
“the safety net fails in other ways”
– That depends on what you include in your safety net. The safety net does also include, but in some perception not always, social virtue.
sdfkjsdhfkhjasdfhkajsdfhkjadfsh
I second Sam Gillett’s comment
The solution as suggested is right in front of our eyes but no politician is bold enough to say this. It is about time we as Doctors will need to do this for our patients who we claim to care for. NHS probably gives us the worst of all worlds . Recently I had personal experience of a health services in another country and when I was diagnosed with ACS, I was on the table in cath lab in less than 20 minutes from presentation in A&E Dept. We need to change our NHS for the good of all of us .
Are health insurance companies available for the good of your health? I do not think so. Why are they so rich? Could they be even meaner than the current party’s Treasury?: that’s right. Look out for your job losses, pensions, working conditions even if you think its bad now: Oh, and you’ll be paying a premium for your health insurance and your family’s, (lucky if you get past the exclusions in your policy) in addition to your MDU. How has commercialisation of anything much helped this country? (under the Blue Party for 13 years, with their Eton and Oxbridge croneys). More than ever, you’ll be an expendable mercenary on the frontline of UK health and you will sorely regret it. Be careful what you wish for. Furthermore, and not least, all patients will become 1st, 2nd, 3rd, 4th Classes of care etc and this will feel so soul-less.
Preventive medicine is a misnomer, the correct term is postponative medicine, where we delay the event by several weeks or months over a person’s lifetime. However for politicians preventive medicine is essential: We know that 10,000 people will get a stroke, that means we have to invest in 5 stroke centres, but if we ‘prevent’ 6,000 strokes we only need to commit to 2 and not 5. That leaves some cash for VIP lane purchases from your mates, and as you, your family, and your mates have enough cash it would not affect you in the first place going private.