So my 16-year-old daughter needed a topic for a 5000-word essay at school. A topic which would be a question, researched and debated in the course of an essay, with a conclusion reached at the end. After a long day at the coal face of the NHS, the immediate question which came to my mind was “Is the NHS financially sustainable?” Helped along by the fact that it was headline news that day. NHS leaders had pronounced that actually it isn’t (financially sustainable) unless the government spades in a load more funding.
But it’s a bottomless pit. We were out with some family members the next day, and I mentioned the plan to write a 5000-word essay on the subject “Is the NHS financially sustainable?” to one of them. “Well that’s an easy one,” she said, “all your daughter has to do is write “No” 5000 times. Job done.”
I take her point. The thing is, medicine has all got a tad more complicated since the NHS began. There are more treatments, and they all cost more money. Here’s just one example. When I was first training as a GP, if we visited someone with chest pain (yes visited, it was a while ago….) and we thought they’d had a heart attack, we didn’t necessarily send them to the hospital. The only point to going into hospital was that if they had a cardiac arrest, they could be resuscitated. There wasn’t anything that could actually be done about their heart attack. Now (and only 25-years later) (am I really that old?) anyone who might get a heart attack (let’s call him Mr X) is blue-lighted into the nearest cardiac unit. Mr X has the blood clot in his heart arteries busted with medicines or surgery, and sent home on 6 different drugs to survive another 40 years. As GPs we then monitor the complications and side effects of those drugs for the next 40 years... this involves more consultations for Mr X, more blood tests and more prescription costs. Then Mr X is more likely to survive long enough to have the complications of his heart attack, such as heart failure, or abnormal heart rhythms (Atrial Fibrillation). Each of those complications will need more prescriptions, more consultations, more hospital referrals, more investigations, and more blood tests. Furthermore, the risk factors for heart attacks are pretty similar to the risk factors for strokes and diabetes, so Mr X may develop those as he’s alive to do so. More blood tests, more consultations, and more prescriptions. He might even hang around long enough to develop dementia.
So that’s just one condition and one treatment, with enormous implications for NHS costs. There are now life-saving cancer treatments, new chemotherapies, more types of operations, newer types of scans, many more expensive medicines available. Not to mention less mainstream treatments such as gender-changing surgery, IVF, obesity surgery, and literally endless treatments the NHS is obliged to fund. All of it is wonderful, don’t get me wrong…. How fantastic for Mr X and his family and friends that he has another 40 years to enjoy life. When I have my heart attack, send me straight off for clot-busting treatment. But my point is, it all costs infinitely more than it did when the NHS began. Which wasn’t all that long after penicillin was invented (In the grand scheme of things, what’s a couple of decades?).
NHS leaders warn either we have to ration what the NHS can provide, or feed more money into the bottomless pit, or see quality fall or it will collapse altogether. Those are the options. Something has got to give.
And that’s the first 600 words of her essay sorted.