Monday, 19 March 2012

In summary: the NHS

As you may have noticed, brevity is not one of my strong points. In my defence, the world's much more complicated than Tories and associated know-nothings believe, and so I require more space to explain why.

But on the NHS, Charlie Brooker sums up my feelings in one sweeping paragraph:
What is it about Lansley that makes human beings hate him so much? It might have something to do with the suspicion that he's hell-bent on turning the NHS into a commercial free-for-all, which for some reason isn't going down well at a time when terrifying nightly warnings about the worst excesses of capitalism are broadcast in the guise of news bulletins. The theory is that introducing an element of competition will improve the level of quality and range of choice for patients. And it doubtless would, if businesses behaved like selfless nuns, which they don't. Any business that wants to succeed has to cut corners somewhere to turn a profit. It also has to juggle a strange set of priorities, which means if you entrust your health to a corporation, the cost of your kidneys could end up being weighed against the spiralling cost of the CGI budgerigar voiced by Joan Collins they want for their new TV commercial.
'Choice' is a mirage. Nobody wants to dial 999 and be presented with a menu of ambulance companies, police services or hospitals. All we want is to know that the local hospital is excellent, and that our taxes are being spent on incontinence pads, NMRI scanners and nurses' salaries rather than off-shored bonuses. Introduce a profit motive and you'll be sitting opposite your doctor wondering if s/he's on commission for that particular drug, got a free holiday (sorry, 'conference trip') from that hip manufacturer, or is on a tight schedule to see X number of patients to make it all worthwhile. And that's before we worry about the masonic and old-boy networks rife in medicine (disclosure: both my parents were NHS doctors).

The other problem with 'choice' is that it can't be informed. Unless you happen to be an oncologist, you won't have a clue which cancer treatments are best, for example. It's bad enough for doctors: the pharmaceutical firms never publish negative results, always publish papers carefully drawn to accentuate often minor gains, and constantly fiddle with treatments not to innovate, but to renew copyrights: the professionals find it almost impossible to make clear judgements. So how the hell is Joe Fatbloke meant to 'choose' his doctor and medication?

What the Tories want is the American situation, in which pharmaceutical companies spend 13.3% of their turnover on research, and 25% of their cash on advertising: $35 billion, or $61,000 per doctor. Yes, you read that right. Money isn't in medical innovation, it's in sales. Which leads to this (and this is only a mild example):

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