NHS in traction
More money won't save the UK health service. Its problems come from the remorseless politicisation of health under New Labour.
A heated debate rages about whether extra resources should be mobilised for the health service through higher taxation or through greater reliance on the private sector.
On 27 November UK chancellor Gordon Brown, fortified by a specially commissioned report from banker Derek Wanless, emphasised the government’s commitment to publicly financed healthcare, a policy favoured by the ranks of Old Labour and the unions. Meanwhile, whispers from Tony Blair’s office at Number 10 Downing Street, advised by rival entrepreneurial consultant Adair Turner, proclaimed the gospel of extending private sector involvement in health, in the true spirit of New Labour.
While it may be true that the UK National Health Service (NHS) suffers from chronic under-funding, a much bigger set of problems results from the remorseless politicisation of health under New Labour. For Tony Blair the health service has become a vehicle for demonstrating the government’s concern for the welfare of the nation and for tackling a wide range of social problems. It is also a key symbol of New Labour’s determination to modernise established institutions and humble traditional professions. The result is to impose an unsustainable burden of expectations on an increasingly demoralised NHS workforce.
Dramatic increases in government spending on health over the past few years have not allayed public concerns about deteriorating standards of care. On the contrary, every week brings new scandals about patients dying on waiting lists and in casualty corridors, even in wards and operating theatres, as a result of failures of a chaotic system or blunders by callous or incompetent doctors. The real problem of the NHS today is that every new initiative causes more problems than it solves.
Take the latest government proposals for cutting waiting lists. The bold new initiative is that some patients will now be able to opt for a fast track to surgery – either at selected private clinics or abroad. No doubt this scheme will be welcome to people waiting for some minor surgical procedure, who are otherwise in good health, who have somebody ready to accompany them for treatment and care for them at home on their return. They should also be able to provide advance reassurances that they will not suffer any of the complications, such as bleeding or infection, which commonly follow surgery.
In other words, this is a scheme suited to an infinitesimally small proportion of NHS patients. Most patients are commonly elderly, frail, physically or mentally ill or disabled, lacking in social support and highly prone to complications.
Though the government’s scheme for boosting capacity in private hospitals at home and abroad will not benefit the vast majority of NHS patients, it is not without consequences for those who will not be eligible for it. The promotion of waiting lists into a major political issue inevitably fosters dissatisfaction among all those waiting for a hospital appointment or for surgery. For some, long delays for treatment may result in prolonged suffering and incapacity. But for many, there is no great hardship in waiting a few weeks or even months for some minor operation. Indeed, it is not unknown for medical problems to resolve spontaneously before the appointed day arrives.
Whereas in the past, GPs and hospital doctors could negotiate around waiting times according to particular need, now all delays have been rendered universally intolerable and unacceptable. But if everybody is to receive instant treatment for every ailment, the resources required to run the NHS are likely to outstrip any form of funding, public or private.
The common result of a wide range of government initiatives in the health service is the inflation of demand. One example is the target of a specialist assessment within two weeks for anybody suspected of having cancer. This widely-publicised performance standard is accompanied by official propaganda campaigns to raise awareness of different sorts of cancer – breast, cervical and ovarian cancer among women; prostate and testicular cancer among men; skin, bowel and lung cancer among men and women. The inevitable result is an explosion of demand for referral to specialist clinics.
In the past, it was possible for GPs to reassure the majority of women with breast lumps and men with testicular swellings that they were highly unlikely to be malignant. In the climate of heightened anxiety about cancer now encouraged by the government, most of these patients now demand referral to a specialist, where reassurance can often only be achieved through invasive investigations.
Sometimes it is important for somebody with what appears to be a malignant condition to be seen within two weeks; occasionally a more urgent appointment is required. In the majority of cases, however, even if the diagnosis turns out to be cancer, it is likely to make little difference to the outcome whether treatment is started in two weeks or two months. In the past, GPs and consultants could collectively exercise discretion in arranging urgent, early or routine appointments. No longer. Now everybody must be seen within two weeks regardless of clinical urgency.
The result is that specialist clinics are swamped with the worried well – and those with malignant conditions may experience delays in starting treatment, as a result of the pressure to meet the two-week deadline for initial assessment of all patients referred. Furthermore, the political priority given to cancer means that in every speciality, patients with conditions which are not malignant, but may be equally distressing and debilitating – and may indeed be more susceptible to treatment – are relatively neglected.
There are many more examples of the perverse incentives that result from ill-advised government initiatives in the health service. The 24-hour phoneline NHS Direct and the establishment of ‘walk-in’ GP surgeries are high-profile New Labour projects designed to encourage the transformation of primary healthcare. The target of an appointment within 48 hours in GP surgeries is another. Together with the relentless advance of disease promotion – every child with a rash and a fever may have meningitis, every person with chest pain may be having a heart attack – this target guarantees an explosion of demand for GP appointments.
Some patients need to be seen immediately, some problems can easily wait a week; many minor illnesses dramatically resolve within 48 hours. But New Labour’s focus groups say that it is intolerable and unacceptable for a citizen not to see a doctor within 48 hours, so primary care is being reorganised so that GPs can meet this absurd deadline.
What is even worse is that, as well as having to meet arbitrary targets, GPs are also being pushed into the frontline of a range of New Labour social programmes. We are expected to take a leading role in preaching the morality of safe sex and deterring teenage pregnancy, in detecting and dealing with domestic violence, in tackling problems of alcohol and drug abuse, in identifying parents in need of ‘support’ and tuition in parenting skills. It is not surprising that GPs have become preoccupied with their own stress levels and with protecting themselves from violence and abuse from patients.
Instead of debating how to raise more money for the NHS, we should start discussing how to end the prostitution of the health service to New Labour’s political and social agenda and how to return it to the treatment of disease and the care of patients.
Dr Michael Fitzpatrick is the author of MMR and Autism, Routledge, 2004 (buy this book from Amazon (UK) or Amazon (USA)); and The Tyranny of Health: Doctors and the Regulation of Lifestyle, Routledge, 2000 (buy this book from Amazon UK or Amazon USA). He is also a contributor to Alternative Medicine: Should We Swallow It? Hodder Murray, 2002 (buy this book from Amazon (UK) or Amazon (USA)).
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