The Trouble with the NHS

Sunday, 27th July 2014

How disease-mongering turns patients into customers

The closest thing modern Britain has to a unifying state religion is universal admiration of the beloved National Health Service or NHS for short, although its remit has expanded considerably since its early days when it aimed to provide essential healthcare to all irrespective of income. As a proportion of national wealth NHS spending has risen from 3.5% in 1960 to over 9% now, that's over 18% of government spending. The fastest rise occurred in the frenetic spending spree of the early years of the new millennium, indeed as recently as 2000 it accounted for just 5% of a smaller GDP, see UK Public Spending . And yet perversely many attribute the failings of the NHS to cutbacks rather than misplaced priorities, crippling bureaucracy and an obsession with targets. As a result of the pervasice tickbox culture millions of older and vulnerable patients are given immune-system-suppressing flu vaccines whether or not they want them or address any of the real medical issues a patient may have, while many real life-threatening diseases are either misdiagnosed or go undetected. It must seem ironic that elderly patients are left in death pathways, while younger NHS customers receive cosmetic surgery such as breast enhancements to combat the perceived curses of low self-esteem and depression. The growing number of clinically obese adults may be entitled to expensive gastric bands because their addiction to high-fat foods is allegedly beyond their self-control, while old people die in freezing homes because their neighbours could not be bothered to check. We have the technology to keep people technically alive in a semi-vegetative state until they are brain dead and to appease any perceived physiological inadequacy. Gender realignment treatment used to be a rather extreme measure, eligible for public funding only in rare cases of genuine hermaphroditism. Nonetheless, as surgical techniques improved many, clearly unhappy with their anatomical gender, opted for private sex change surgery. One Iraqi-born millionaire even underwent two gender reassignment operations, and many others have suffered from greater emotional turmoil because of dissatisfaction with the outcome of their life-changing surgery than they ever had when they felt trapped in the wrong body. Yet despite widespread public scepticism of its effectiveness, this invasive surgery is now available on the NHS and to suggest otherwise is now deemed transphobic, a term coined on the back of homophobic. Another growth sector is the murky domain of mental health. According a Nuffield Trust report, mental disorders cost the English NHS £12 billion in 2010, more than double the total spend on cancer. A longer term but welcome trend since mid 20th century has been longer life expectancy and a greater survival rate from diseases that would until recently have been irredeemably terminal, so one way or another health spending has risen in most wealthy countries.

The last European elections even saw the emergence of a new party, the National Health Action Party (NHA), which fielded candidates only in the London region. It has a very active campaigning team both online and among London-based NHS staff. They not only oppose privatisation, but also all cutbacks in NHS spending. This stance appeals to a large cross-section of left-leaning public opinion. However, their simplistic analysis has one small flaw. Government spending on healthcare has increased dramatically since 2001 and has continued to grow even under Conservative and Liberal Democrat alliance. The figures are publicly available. In real terms UK healthcare spending doubled from 2000 to 2010 and has continued to grow very modestly since, currently some £130 billion or 18% of public expenditure or 9.1% of GDP. To be honest this is largely in line with healthcare spending in countries with comparable living standards. But mileage or rather value for money varies. The USA has the highest level of healthcare spending in the world, but yet many much poorer countries have a higher life expectancy. Most notably Cuba and the US have the same mean life expectancy, but in US dollar terms US healthcare spending is astronomically higher. In the US an estimated 100,000 people die every year of inappropriate prescription medication, competing with Unintentional Injuries and Alzheimer’s disease for the fifth most common cause of death.

Clearly if we expect our health service not only to cope with the challenges of an ageing population, but also to meet growing demand for lifestyle medicine (cosmetic or performance-enhancing treatment), we must be prepared to pay for it. The recent rise in lifestyle medicine, especially cosmetic surgery, has transformed beauty and wellbeing from gifts of nature into commodities. As a result fairly average imperfections, from misaligned noses and teeth, undersized breasts, balding hair, erectile dysfunction, once considered just unfortunate facts of life, are now treated as major causes of depression and prime targets for medical intervention.

That means we need to decide as a society which categories of healthcare we should socialise and which categories are best left to personal discretion (or in my humble opinion actively discouraged as they destroy social cohesion by emphasising the power of money to transform one's body beyond essential medical need). Certainly if someone endures a tragic accident or succumbs to a debilitating disease, it seems very unfair for their prognosis to depend on their bank balance or ability to pay into a generous health insurance scheme. Socialised healthcare means if you fall victim to injuries or illness beyond your reasonable control, then society as a whole will pick up the bill. However, by redefining physiological imperfections and emotional distress as illnesses, the multibillion pound medicalisation business has significantly boosted healthcare costs. As these costs spiral out of control, we risk throwing the proverbial baby away with the bath water. We all need essential medical care at times in our life. If we are generally healthy, this may mean just regular checkups with the odd vaccination (another controversial topic) and for women a short stay in hospital to give birth. Natural human diversity means we are not all blessed with perfect bodies or physical performance potential.

However, socialised medicine also requires social cohesion and solidarity among the different groups within society. While we delegate responsibility to medical professionals, at all times they must serve our needs, not those of disease-mongering pharmaceutical multinationals or invasive state apparatuses. We should not become mere customers or guinea pigs for medical experiments, but be empowered patients, who just want an honest diagnosis and impartial evaluation of medical options. If we expect others to subsidise our healthcare, then we have a responsibility to look after ourselves as best we can. If I decide to engage in a high risk activity for my own pleasure, it seems reasonable that I take out additional insurance. Why should others foot the bill for expensive restorative surgery, if some daredevil motorcyclist decides to jump over 10 double decker buses ? The point is as medical technology evolves, we must clearly define genuine medical needs, otherwise we will just sleepwalk into the collapse of the National Health Service as we knew it and healthcare will be just a profit-making business. Indeed this is already happening albeit underwritten by taxpayers and banks. As Professor Allyson Pollock reminds us "Virgin landed a £630 million contract for community mental healthcare, with no previous experience, while RBS, Serco and Carillion, to name but a few, are raking in billions in taxpayer funds for leasing out and part-operating PFI hospitals, community clinics and GP surgeries.” A private company now runs an NHS hospital. US private medical companies are now involved in the privatisation process, such as HCA and United Health. HCA is in a joint venture with University College Hospital London, where it provides cancer treatment, but only for those who can pay. Both New Labour and the current Conservative/Lib-Dem coalition have turned the NHS into a front for a rapacious biomedical business.

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