As a GP who defected to Canada, ‘God Bless the NHS’ are words I have never uttered; it is a sentiment felt deeply however by many patients, who have an enduring love affair with this most British of institutions.
In his thoughtful book, Roger Taylor, co-founder of Dr Foster, provides a wide-ranging discourse on the NHS.
Beginning with a discussion around the 290 recommendations from the Francis Report into mid-Staffs (enough to ‘make the man and woman in the Clapham GP’s waiting room despair’), he explores our relationship with the health service, arguing it is ‘part of our national story ... part of our national myth’; proposing the NHS is not an unusual healthcare system, but what is odd is our connection with it.
He describes politicians as intent on reform, at a time when patient satisfaction has never been higher. David Cameron is described as being ‘like a creepily possessive boyfriend’ when he declaimed ‘it’s because I love the NHS so much that I want to change it’. Yet change it must, Taylor argues, despite the protestations of ‘sustainability deniers’. He focuses (perhaps unduly) on advancement in medical technology as the cause of rising costs.
He touches on the conflict between medicine and money, clinical freedom, clinical variation, and referral centres, which he thinks ‘combine the worst of all possible worlds’, reviews the role of the private sector proceeds via cataract surgery in India, and writes about centralisation of specialised services and the need for politicians to make unpopular decisions.
Tackling the difficult question of whether good care can be measured, Taylor suggests that the only way is for as much data to be obtained as possible and for it to be analysed in a subtle, nuanced way, akin to Francis.
Reasonably, he says that data should be used to inform judgement, not as a substitute for judgement, but who should bell the cat in the absence of a bench of QCs available for quotidian NHS decision making? Taylor thinks that it should be the patient.
The last part of the book is less persuasive. His answer of better access to medical records and idealistic patient empowerment, with patients contributing to their own medical records, discussing their health not with one doctor but with ‘a number of doctors who are expert in their areas of knowledge’, through a ‘medical service ... that can put you in contact with whoever you need — by phone, online, or in person — 24 hours a day, 7 days a week’ is unconvincing.
Not many patients will have the wherewithal of Jill Maben, a nursing professor who used the internet to track down an Australian surgeon for her son, disabled by epilepsy from a hypothalamic hamartoma. The great strength of the internet is ease of access to information, but there is no quality control. His assertion that the most powerful source of information is other patients is only true to a point. In Taylor’s own terms, this would seem to be relying too much on a single data source.
Ultimately he is guilty of making the same mistakes of which he accuses others, confusing medical technology, healthcare institutions, and individuals, when he plaintively laments:
‘The NHS has the power to destroy a brain tumour with radiation and replace a malfunctioning heart with an artificial one; Yet at the same time it is capable of leaving a patient crying in agony all night because there is no-one available to provide pain control.’
As may be expected from Taylor’s background the analysis is sound and thought-provoking, even if his solutions are rather nebulous, and God Bless The NHS is a worthwhile read.
- © British Journal of General Practice 2013