Nick Summerton: Threat to publicly-funded health care from obsession with controlling costs

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MOST people who enter a profession such as medicine or the law might predict that they will be expected to do more than the bare minimum for their clients. However, working as a doctor in today’s NHS is different.

Over recent months, I have earned considerably more praise from my NHS managerial colleagues by prescribing fewer medicines, arranging cheaper tests, referring fewer patients to specialists and spending less time in my surgery seeing patients.

Yet, during the course of one week last December, I only consulted for half a day – the rest of my time was spent on non-clinical tasks, and to the irritation of many of my patients.

One of the currently favoured solutions to control the rising costs of NHS care is to allow a number of new providers to compete to deliver services. At one point, I thought this sounded a sensible idea – until I found out that I would now need to spend several days out of my own practice to write a 104-page tender document.

Moreover, should our practice be awarded the tender, the only thing that we will have achieved for all the time wasted on this process is to be able to deliver exactly the same services to
our patients as we do at the moment.

Increasingly it seems to me that a kind of madness has taken over the NHS. Driven by an obsession with controlling costs, the very essence of publicly-funded health care is now under threat. Even if I do send a patient to see a hospital consultant, the appointment is now very likely to be delayed, diverted to a nurse or, more recently, simply rejected.

Back in 2009, in addition to being subjected to a further reorganisation, the NHS was instructed to make £20bn of efficiency savings by 2015, with such money being reinvested back into direct patient care.

However, not only does it seems unlikely that this target will be attained, Parliament’s Health Select Committee has recently highlighted a lack of clarity as to where any savings have actually been spent. The only certainties are that over 7,000 clinical staff have been made redundant since 2010 and a third of NHS hospitals are now in dire financial straits.

One thing that particularly concerns me is that the NHS now appears to be compromising on quality to save money. In seeking to pick up cancers at an earlier stage, when they might be cured, some of the tests being offered seem to have been selected more by considerations of cost than effectiveness.

For lung cancer, a chest X-ray is a poor substitute for a lung scan and a test for blood in the a patient’s stool is much less likely to pick up bowel cancer than directly visualising the bowel wall. Even once a cancer is diagnosed, the National Institute for Health and Care Excellence has expressed enormous concerns about the variations in access to some key cancer treatments across the NHS.

One of the fundamental assumptions that underpinned the introduction of universal health care back in the 1940s was that the demand for medical treatment would diminish as the nation’s health improved. In fact, the opposite has happened.

Increasing life expectancy means more people live to an
age where they suffer from one
or more diseases that are expensive to treat. We are also less pre-disposed to queuing and rationing than our parents or grandparents.

We struggle on to try to maintain a creaking publicly-funded health service that will soon become unaffordable. A report last year by the King’s Fund predicted that, if NHS spending grows at the same rate as over the past half-century, it will take up 20 per cent of the UK’s gross domestic product by 2050.

The overarching problem is that we have turned the NHS into a God-like entity that simply has to be sustained as if there is no alternative. Our Greek and Roman forebears paraded their deities at sporting events and reproduced their images on coins: intriguingly we are now doing exactly the same with the NHS.

The position adopted by the current government is nicely summed up in the recent statement by Earl Howe, the Health Minister: “Having a universal health service free at the point of delivery makes us the envy of the world. No politician who values their career has ever had the courage to say anything different.”

So, perhaps the time has come to recognise that ritualistic genuflection before the almighty NHS is no longer appropriate. The harsh truth is that we can no longer afford to deliver all the free care we would like to.

Nervously, we have only tinkered around the edges, with some patients being asked to pay for prescriptions, opticians and dental care. Attempts to ration other treatments or suggest that some patients might need to contribute to their care have been, at best, half-hearted.

We now urgently need an open and honest debate about what care the NHS should provide and what it should not.

• Nick Summerton is a GP in East Yorkshire.