Back to the future: aspects of the NHS that should never change—an essay by Iona HeathBMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3187 (Published 25 July 2018) Cite this as: BMJ 2018;362:k3187
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In her essay on NHS culture Iona Heath looks back to a culture of frugality which she feels is the way to avoid the trend to overdiagnosis and overtreatment in contemporary medicine. In fact, that frugality was very harmful.
In an essay I wrote in 2000 I described how that culture of frugality was harmful to the care of patients with cancer. Each professional group saw its obligation to protect other diagnostic or therapeutic services from excessive workload leading to a failure to recognise what capacity was required. I subsequently wrote an editorial in which I commented on the limited progress that had been made in the following decade and the fact that there were some hopeful signs.
That editorial was peer reviewed. The following quotations come from an anonymous reviewer.
“British cancer care lagged and lags despite the fact that the UK was/is one of the leading nations for academic oncology. The deficiency was not in the ‘in-house excellence’ which UK Inc held, but in the access of citizens to that excellence…As a closely located [Ireland] but external observer of these events, it sometimes seemed that some UK colleagues thought it at least disloyal to the NHS, and perhaps actually treasonous to admit that deficiencies existed.
“Dr. Crawford correctly identifies the quirky British GP system and its sentinel-like gate-keeping function as a principal barrier. Such gate-keeping cannot by definition enhance the quality of care of patients. It is a cost-containment exercise par excellence. It is this system which allows the UK to have such an extraordinarily low number of specialists per head of population compared to all of your European peers. It consistently surprises me how accepting most UK hospital consultants are of this profound numeric abnormality.”
1] Heath I, Back to the future: aspects of the NHS that should never change—an essay by Iona Heath. BMJ 2018;362:k3187
2] Crawford SM Cancer in the UK- A question of culture. Eur J Cancer, 2000; 36: 1909-12.
3] Crawford SM Cancer care in the UK: updating the professional culture. Postgraduate Medical Journal, 2011; 87:243-244
Competing interests: No competing interests
I congratulate the NHS for its outstanding success and agree that the values on which the NHS is based should not change. I had the opportunity to work in the health systems in other parts of the world. Joining the NHS two years ago gave me mixed feelings. I appreciated the quality of services that the NHS is providing to the general population, which is at par or even better than the care patients receive even after paying huge sums of money in other parts of the world. At the same time, some patients fail to appreciate the worth of this invaluable healthcare available free of cost in the NHS. On many occasions patients don’t turn up for their clinic appointments or operations without informing the hospital beforehand. These wasted slots cost the hospitals a considerable amount of money and also take away the opportunity for other patients on the waiting list to have timely treatment.
A few measures should be taken to make patients aware of their responsibility so as we can use these scarce resources more efficiently. For example, if a negligible fee is applied for booking an appointment and the same is refunded when the patient attends the clinic, it will probably make people more inclined to attend the appointment.
Many of the patients requiring urgent tertiary care treatment (for example, cardiac or neurosurgery) are brought by ambulance to district general hospital emergency departments, requiring further transfer to tertiary care hospitals. If these patients are taken directly to the places where they can have the required treatment, not only would the patients receive timely treatment but a the wastage of time and resources would be reduced in district general hospitals with limited manpower. More education for the ambulance crew to choose the appropriate hospital for patients may help to ameliorate this problem.
Some unnecessary investigations can be avoided by stressing the need for appropriate application of clinical knowledge during the induction of junior doctors.
The NHS is a world class health care system. I truly wish and hope that it would maintain the high standards in the future by efficient and effective use of limited resources.
Competing interests: No competing interests