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News

All main political parties’ pledges for NHS will prove inadequate, says former chief executive

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2081 (Published 16 April 2015) Cite this as: BMJ 2015;350:h2081

Rapid Response:

How to save the NHS: a patient's view

All political parties are concerned to save the NHS from further cuts. One way of helping might be to avoid unnecessary expenditure on expensive operations and drugs that could well be avoided if patients were given genuinely holistic advice. I have recently described my own experience of managing to avoid a hip replacement since 2001 by seeking complementary treatments, which were recommended in the first place by an orthodox orthopaedic surgeon. (1) Also, perhaps much medication is unnecessary, as my husband found when two drugs he had been prescribed after his stroke were causing problems, which stopped when he came off the drugs. (2)

It is true that I have been able to fund a modest amount of complementary therapy myself (for example, acupuncture, osteopathy, supplements). But there is no reason why these should not be available on the NHS. The only problem, we are told, is the 'evidence base' for their efficacy. But what evidence do we actually have for the efficacy of some widely prescribed treatments, for instance, paracetamol for osteoarthritis? (3).

Another common problem is that although NICE recommends talking therapy for anxiety and depression,(4) it is still difficult to obtain this speedily on the NHS, and the prescription of drugs tends to take precedence. However, in many areas there are community resources to fill the gap: voluntary counsellors, or those requesting only a donation. GPs are often not aware of these, or perhaps regard them with suspicion. When people in distress may have to wait as much as six months for access to talking therapy (often limited to CBT) on the NHS, the situation is serious. It should be simple for GPs to be given information about local community resources: how often is this done? And yet we talk about health and social care integration.

The borderline between 'orthodox' and 'complementary' treatment is ill defined. Glucosamine sulphate used not to be available on NHS prescription: now it is. (5) In 1986 (when I was treated for breast cancer) the idea that diet had anything to do with cancer was ignored by orthodox medicine: the Bristol Cancer Help Centre was regarded by many clinicians as beyond the pale. (6) And yet my GP could prescribe the supplements recommended by the Bristol centre on the NHS. Now, moreover, no respectable cancer centre is without its department of complementary care, its 'Maggie's Centre', and 'five-a-day' is mainstream dietary doctrine, even if hospital menus still lack fresh fruit.

A great deal more could be done in the way of preventative healthcare: how many expensive gastric bands (or cases of diabetes) could be avoided if people were helped to change their diet and take more exercise? Or indeed offered counselling/psychotherapy? Hospitals need to start with their own staff: we all know of examples of healthcare workers who are seriously overweight.

We do not need to stock the pharmocopoeia with even more expensive drugs, some of them only used to prolong life by a few weeks at the cost of horrible side effects, when psychotherapy would enable patients to face terminal illness with acceptance and equanimity. As a long-term cancer survivor, I would rather face death when it comes without too much fuss. I can well understand that sometimes patients have unfinished business in the way of, perhaps, the marriage of a son or the graduation of a daughter, for which they will undergo a great deal to remain alive, but this is not always true. Each person must decide individually: but also, each person must be given the facts, as far as they wish to know them. In the past this was not the case. At least now doctors don't patronise their patients with talk of 'naughty cells'.

It is obvious that integration of health and social care should enable savings to be made. This is not always easy, and everyone knows of examples of cases where the provision of safe home care to replace unnecessary 'bed-blocking' is difficult to arrange: but it must be done, especially with the increase in the elderly population. It might also save money if GP practices were to include in their premises access to services such as podiatry, psychotherapy, and benefits advice: this is already done in some areas. We need joined-up thinking on the part of doctors and patients: they both need information about complementary services, which should be easily accessible, and not only 'on the website', which many elderly people cannot access.

We simply cannot afford to ignore any services that might help patients recover their health and wellbeing. My own experience of being able to access complementary therapies has, I believe, kept me alive long past the date when, according to the Nottingham Prognostic Index, I should have died. As a consequence I treasure each new day, and I have been able to continue with a variety of voluntary work well into my ninth decade.

We should not be too worried about the increase in the elderly population. Though some of us need more healthcare resources than younger people, many of us keep the show on the road with our voluntary work in hospitals, care homes, community councils, parks and gardens, orchestras, art galleries, and so on. We have known a time when there was no NHS: we love it too much to allow it to decay. It can get better and cost less, but only if it makes use of all the expert complementary care that is available in the community.

References

1. Goodare HM, rapid response to 'Managing back pain and osteoarthritis without paracetamol'. BMJ 2015;350:h1352.

2. Goodare HM, rapid response to 'Discontinuing Drug Treatments'. BMJ 2014; 349:g7013.

3. Machado GC, Maher CG, Ferreira PH, et al. Efficacy and safety of paracetamol for spinal pain and osteoarthritis: systematic review and meta-analysis of randomised placebo controlled trials. BMJ 2015;350:h1225.

4. National Institute for Health and Care Excellence. Depression in adults: The treatment and management of depression in adults (CG90). 2009.

5. POEM (Patient-Oriented Evidence that Matters): Glucosamine improves joint mobility for 1 in 5 patients with osteoarthritis. BMJ 2003: 327 (6 December), doi 10.1136/bmj.327.742, 0-1.

6. Goodare H (ed.) Fighting Spirit: the stories of women in the Bristol breast cancer survey (Scarlet Press, London 1996).

Competing interests: No competing interests

28 April 2015
Heather M. Goodare
retired
Edinburgh Health Forum
Edinburgh EH3 9LL