WE NEED TO TALK ABOUT HEALTHCARE

Former health secretary Sajid Javid was pilloried for asking if free, universal healthcare has a future in the UK. The episode demonstrated clearly why we can’t even begin to consider reform of health provision, until radically rethinking the way in which the issue is discussed and debated, writes Ivor Campbell

The NHS has been likened to a 74-yearold patient who has not been taking good care of themselves.

Record waiting lists, full wards, blocked beds, ambulances queuing outside casualty departments, patients dying unnecessarily, nurses out on strike and public satisfaction in freefall – what a pitiful roll call of institutional ill health.

It’s a million miles from the confidence of 1948 when the service was founded, as part of a radical government plan to rid the nation of ‘want…disease, ignorance, squalor and idleness’. The debate about where it goes from here has not been short of contributors – politicians, think tanks, NHS staff, journalists, and many more, have all had their say. It has even been suggested that a citizens’ assembly should be set up to determine the future of the health service.

With few exceptions, they talk about a lack of resources –hospitals need more beds, wards need more staff, staff need higher wages – and, in the background, the Government is dealing with some of the most challenging economic conditions we have ever experienced as a country. Those who propose spending more money on the health service inevitably cite a ‘special case’ defence, when it’s pointed out there is no more money. They accept that budgets are tight, but surely extra can be found, because health is not like other government departments.

There’s an impenetrable, circular logic to public discussion of the NHS that makes criticism redundant, leaving sceptics craving a darkened room in which to lie down.

At its heart is the argument that any attempt to improve the health service by means other than additional public funding is secular heresy.

Last month Sajid Javid, the former secretary of state for health and social care, became the highest profile figure yet to question whether the NHS can survive in its current form, or whether we should now confront the option of making some people pay for some provisions. Javid, who will stand down as a Tory MP at the next election, suggested the possible introduction of a fee being charged for certain appointments. Such charges exist in some other European countries, for example in Norway patients are required to pay around £20 required to visit their GP, while in Ireland the cost of attending a hospital A&E department is around £75. Leading the voices of condemnation against Javid was former Labour prime minister Gordon Brown who accused him of ‘testing the water for a different kind of NHS’. Efficiencies welcomed in other areas of public service like eliminating waste, merging duplicate provision, seeking cheaper alternatives, automating processes or – lord forbid –involving the private sector – are immediately denounced as equivalent to ‘profiting from sickness’.

The reality is however, that injecting extra money into healthcare provision, even if it was available, would do little to improve performance because – and even its staunchest supporters agree – the NHS is a bottomless pit. Don’t take my word for it, there’s a recent case study of what happens when ministers pile endless amounts of cash into the NHS.

At the start of his second term as prime minister, Tony Blair committed his New Labour government to matching European levels of spending on health, rising from seven per cent in 2000 to more than nine per cent by 2008.

To give you an idea of the scale of this financial outlay, it entailed, by 2003/04, spending £63.7billion on the NHS with, by far, the largest proportion going on staff wages. And the result? Writing in the Lancet in May 2007, Hannah Brown said: “Ten years of New Labour health reforms have injected badly needed funds into the UK’s National Health Service. But through repeated restructuring and micromanagement, Blair’s government seems also to have eroded clinicians’ flexibility to care for patients.”

To accompany his high spending, Blair’s reforms amounted to introducing an element of competition among different elements of the health service, but with the crucial proviso that outside competition from the public sector remained verboten. By 2015, Phil Whitaker, writing in the left-leaning New Statesman –in an article headlined ‘How Labour broke the NHS’ – concluded: “Labour finds itself in an embarrassing position: the party that began privatisation has to explain why that process – which has, after all, resulted in improvements in the elective-care arm of the service – is simultaneously incompatible with meeting the present-day challenges the NHS faces.”

Making decisions that appear sensible at the time but which later turn out to be foolhardy are not, of course, restricted to politicians. I recently unearthed an article from the British Medical Journal (BMJ) from 2008, where The BMA (British

Medical Association (BMA) had just voted, albeit marginally, not to increase the amount of medical training in the UK because, they thought, it would devalue the profession and suppress wages.

Scottish First Minister Nicola Sturgeon also cut the number of medical nursing places, believing that we had too many doctors and nurses and, if we needed more, we could always import them from overseas. Perhaps we shouldn’t expect our politicians – with all the resources of the civil service and their coteries of special advisers on tap – to be able to foresee changed circumstances a year or two down the line.

How we now deal with the current record shortage of NHS staff, appears to be anyone’s guess. With no-one available to fill them, the fact that there is no money to do so appears moot. Even if the funding was available, we can’t train new doctors in six months.

Meanwhile, significant changes to primary care appear to have crept up on an unsuspecting population without forewarning. As recently as a decade ago, patients were generally able to book a same-day appointment with their local GP. Those with slightly longer memories may remember when GPs visited you at home and when GP surgeries doubled as minor injuries clinics, where you could go to be treated for minor cuts and bruises.

Now GP surgeries have turned into little more than glorified triage services and the local hospital is effectively the first port of call for any patient suffering from anything more serious than a sore throat.

No-one voted for these changes and yet we are now paying higher taxes for a service that used to be significantly better. And if anyone complains, they are accused of ‘talking down’ the NHS. Working taxpayers are now forking-out the equivalent of a fairly expensive private healthcare plan, in return for a rudimentary accident and emergency service. If you see a doctor at all now, you now need to be really quite ill. Before we can have a mature discussion about what to do about the health service, as a nation we need to agree to radically reframe the terms of debate.

First to be addressed should be commonly peddled conspiracy theories that any politician who is seriously intent on reform, must be trying to line the pockets of his, or her, mates, running medical supply companies. While this had undoubtedly happened in the past – and I can think of at least one current, high profile example – it is far from being rife and any politician on the make could surely find many more efficient ways of making large sums of money quickly. Another straw man that needs confronted is the notion that any attempt to make the health service more efficient, is ‘privatisation by the back door’. The NHS is a hugely inefficient bureaucracy that haemorrhages money and the only people madder than anyone willing to sell it, would be those willing to buy it.

Reframing the debate around the NHS and introducing reforms are both necessary and more urgent than many people believe. The staffing crisis will only deepen as medics trained in the 1980s are now starting to retire and not being replaced. There are unsupportable stresses on the system that can only get worse.

Wherever you look, people are testing themselves for conditions that, a year-ortwo ago, they had never heard of. In the blink of an eye, it seems that self-diagnostics is the new yoga and wearable technology the new jewellery. There’s a certain irony in the fact that the global health crisis caused by the Covid-19 pandemic appears to have sparked the biggest healthcare revolution in a generation, with a massive growth in self-testing.

Until recently, there was a handful of tests available at your local high street pharmacy, most commonly to find out if you were pregnant or if you had a urinary tract infection. Other than for that, the only people routinely testing themselves were those with specific conditions such as diabetes or HIV.

Now, it seems, that whatever you want to test for, there’s a diagnostic kit that can be bought online or at a chemist’s store. Samples taken can either be processed at home, or sent to a laboratory for screening, diagnosis, monitoring, or to provide information about the risk of a disease.

There are some encouraging signs, including in the medical technology sector, where advances are helping to automate expensive, manually done tasks. Telemedicine, artificial intelligence, gene-editing technologies and synthetic biology will all have a role to play as health service providers look for more efficient ways of treating higher numbers of patients with fewer resources. Rather than throwing endless amounts of good money after bad, governments should use some of the NHS budget to offer tax incentives and prize money to health innovation and medical technologies companies. Why is there no current equivalent in medical technology of the Longitude Prize, where funds are offered to graduates and start-up businesses that can help to solve particular clinical problems?

The NHS is currently in the intensive care ward. The length of time it takes, before it can be moved back into a general ward and, ultimately, discharged, will depend on how quickly we change the nature of discussion around it.

Ivor Campbell is Chief Executive of Callander-based Snedden Campbell, a specialist recruitment consultant for the medical technology industry

Among the various things you can now test for at home are blood, iron, testosterone, diabetes HbA1c) thyroid func- tion, vitamins B9 & B12 and D, choles- terol, liver function and Omega-3. You can screen for glucose, gluten and lactose intolerance, digestive problems, anaemia, and stomach ulcers, muscle type or fat DNA (to find out if you have a predisposition to obesity) and you can also check your skin, foot, and nail fungus DNA.

If you have a spare £6,742.80 lying around, you could even invest in a Portable Point of Care Testing Device which uses ‘cathodic electrochemiluminescence technology’ to test for a complete range of potential conditions.

What some people – mainly those selling the tests – are calling the ‘democratisation of healthcare,’ is seen by others as the opening-up of a whole new market in hypochondria, or what is now called ‘illness anxiety disorder.’ As a general principle, having more information is better than having less, but I’m sure we can all think of at least one person who doesn’t need any more encouragement to look for more things that might be wrong with them. An inevitable consequence of the growth of home testing is a corresponding increase in primary care consultations. For self-testing provides only a starting point for people to use the information they have gained to then seek professional advice and treatment.

Those who might, in the past, have struggled on regardless with an ache here or a grumble there, now have a data set to justify their complaints. Where before we lived in blissful ignorance that we had an abnormal reading in our levels of vitamin B9, B12 or Omega-3, now we have a test kit with lines and markers to justify our conviction that we reside in the land of the unwell.