The NHS is nowhere near crisis point yet
BMJ 2018; 361 doi: https://doi.org/10.1136/bmj.k2663 (Published 19 June 2018) Cite this as: BMJ 2018;361:k2663
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Dear Editors
I cannot help but point out a fundamental flaw in Mr Page's opinion piece in which he suggested the NHS is not in crisis on the basis of comparison to what other crises were defined by. He argued that the perceptual lag does not reflect actual performance indicators and hence what we are feeling is not what is truly happening.
The irony is that if the public perceive a low (or high) point has been reached, this perceptual lag is by definition, already preceded by the NHS performance trough (or peak) by months.
So the NHS probably did reach a crisis point, months ago. Yes, many of us can smell fear even before the NHS managers release the next round of mortality figures and performance indicators
Even without the performance data, it is obvious that the NHS leaders have lost their way, authorising new programs without waiting for concrete cost-effectiveness studies (for example, implementing low-dose computed tomography for lung cancer screening) and pushing for new technology and drugs while stripping incumbent low-cost moderate efficacy programs.
Sure, excessive management can obstruct innovation and change for the better, but the way that resources and monies are now allocated is no different from being on a spending spree with someone else's hard earned money.
Not that the public is immune from this attitude, however.
Some patients expect the system to give them the treatment they know from past experience over many years has worked for them, whether or not the doctor thinks it is “evidence based” or not. These opinions are being voiced in the BMJ arena and remain largely unchallenged.
Evidence-based medicine? For everyone else but me: just give what I want!
By this logic, we should still be performing bloodletting on our patients, handing out morphine to addicts and performing useless operations simply because patients demand it.
In this age of the consumerism-entitlement complex (emboldened by misperceived ease in accessing medical knowledge on the internet), unless this mind-set is curbed, the general dissatisfaction from "not getting what I want" outrage will not only accelerate the arrival of a crisis point but also intensify the magnitude of it.
Mr Page is ultimately right to assert "changing people’s attitude to their health and their bodies is fundamental" and "until society itself has changed its attitude and behaviour and the NHS has changed alongside it, it will never have “enough” money, but the NHS itself has to provide the “nudge” to help make this happen.".
Boy, do we have a big task ahead of us.
Competing interests: No competing interests
Ben Page makes some interesting but debatable points. He is right when he writes that "Changing people's attitude to their health and bodies is fundamental."
Yes, a societal change is needed for this. Many conditions that the NHS has to deal with are due to patient lifestyle choices. I would suggest NICE Guidance for Patients with patient choice at its heart and medical interventions limited until those lifestyle choices are truly optimised.
Competing interests: No competing interests
Re: The NHS is nowhere near crisis point yet
Mr. Ben Page emphasised that "changing people's attitude" is fundamental. We all agree that more work is needed to raise awareness and change behaviours as a public health approach. However, discussing this as a solution to under-funding means we are mostly blaming the public for the current situation. Last year, we heard about plans by some trusts to offer people money if they can house patients following discharge if the patients lived on their own [1] As the demand for both acute and regular care continues to increase, the rate of increase is in funding remains slow compared to the average since the NHS was founded [2].
I would argue that changing governments behaviours would be at least as important as changing those of the public. Not only when it comes to funding priorities but also for example, the idea of constant re-organisation which David Oliver nicely described it as a "political vanity project" [3].
Also, we could argue whether the current situation can be described as a crisis or not, but, to say the NHS is "nowhere near" one sounds very optimistic. Last year, The King's Fund reported that overnight bed occupancy was around 79% in 2016/2017 and "regularly exceeded 95 per cent in winter, well above the level many consider safe" [4]. I would say this, combined with staff shortages and an increasing demand, is very concerning.
References
01. Illman J. Exclusive: Airbnb style company bids to place NHS patients in spare rooms. Health Service Journal. 2018.https://www.hsj.co.uk/service-design/exclusive-airbnb-style-company-bids... (accessed 27 Jun 2018).
02. The NHS budget and how it has changed. The King's Fund. 2018.https://www.kingsfund.org.uk/projects/nhs-in-a-nutshell/nhs-budget (accessed 27 Jun 2018).
03. Oliver D. David Oliver: Constant structural reorganisation won’t improve or transform healthcare. BMJ 2018;:k2433. doi:10.1136/bmj.k2433
04. NHS hospital bed numbers. The King's Fund. 2018.https://www.kingsfund.org.uk/publications/nhs-hospital-bed-numbers (accessed 27 Jun 2018).
Competing interests: No competing interests