Dear Mr Hunt,
The NHS is in crisis. I’m sure, by now, that someone in the upper echelons of the service must have fed this back to you.
But just in case you’re cocooned in some cloud cuckoo land where your trusted advisors have persuaded you that no doctors can be trusted on any subject whatsoever, and especially not scaremongering about the parlous state of the NHS, then you might want to pop along to your own GP or local hospital, unannounced, to see the crisis at first hand.
The demand on the NHS has reached breaking point.
The problem is due to multiple causes, people are getting older and, sad to say, if you’re old your body doesn’t work so well and you can have multiple health problems. Historically these problems were solved by the grim reaper.
When Lloyd George set the pension age 100 years ago, only 1% of the population actually lived long enough to draw a pension. Now many people live a third of their lives as pensioners. Live expectancy has increased from 50 years in 1916 to over 80 years today. Modern medicine is partly responsible but it is predominantly due to better social conditions and higher standards of living across all cross sections of society.
Even though we, as a nation, spend a relatively small fraction of our GDP on health care, money is still a main issue. If we had unlimited funds then everybody would be entitled to the very best care – however we do not, hence services need to be rationed in some way. Furthermore around the corner, ever more expensive treatments are being developed which will almost certainly be beyond the means of the NHS.
I have said that unlimited funds would result in everyone getting the very best care – but this might not be in everyone’s best interests – in the US where the super-rich have limitless funds, their health suffers as a result. Over investigating and treatment for them results in a slightly shortened life expectancy. For example their benign prostate cancer is much more likely to be treated overzealously with lots of adverse problems.
I have felt for a long time that the real problem in the NHS has been a bureaucratic behemoth which has grown out of control. Its underlying driving force is the mantra that tax payers money funds the NHS and it has a responsibility to ensure that every penny spent on the NHS has been wisely spent. This in itself would be fine, but I suspect the mandarins high up in the NHS define wisely spent according to the Daily Mail’s definition – ie that no one should profiteer from the NHS.
We have over the last 30 years built a series of institutions and rules which govern how health and social care should be managed and run. The defining issues are to ensure cost effectiveness, safety, fairness and so on. All very laudable but the systems imposed have thrown the baby out with the bath water.
Let me give you an example.
When I became a GP 30 years ago, most care homes had about 3-4 residents all of whom were treated like the owners own parents. They felt part of a family and received superb care. However these homes sank under a burden of bureaucracy – having to install lifts, fulfil stringent health and safety guidelines and so on. We are now facing a social crisis because even the largest homes are unable to financially survive in a cash strapped service. It is ironic that those homes which we forced into closure probably could have survived today’s harsh financial climate.
Those same pressures which we subjected small homes to are now being felt by the vast majority of general practices which are in turn being forced into practicing into larger and larger units. I have an awful feeling of deja vu. The bureaucratic behemoth doesn’t realise that the flood of paperwork its pouring into the bath has drowned the baby.
So what we need to save the NHS is a massive boost to the economy and the extra cash all to be invested in the NHS. Umm, let me check out of the window, nope can’t see any pigs flying, so that’s a no hoper.
Ok if we could turn off the bureaucratic tap – let me check again, nope still no piggies to see.
Ok finally if miraculously suddenly everybody got better, they became less ill that would mean the burden on the NHS would drop and hey presto all is solved. Now let’s look. Amazingly with my telescope on the distant horizon I see a little piggy that’s definitely picking up speed on the runway.
Let me explain a bit further.
Last month I was fortunate enough to piggy back on my son’s trip to an international Webinar in Lisbon. He’s into IT techy stuff and my wife and I were into a few days in Lisbon (a great place if you get the chance to visit). However I also had a pass to the Webinar and attended the health related conference on the final day.
I wasn’t expecting a lot, just a few talks from start ups about using Apps to help connect doctors and patients, which was indeed what most of the talks were about. But then I went to a talk by a start up company called Freenome. This is an American based company who are doing some revolutionary stuff looking at how we diagnose and screen for cancer.
I was immediately hooked because doctors are trained to treat disease. I might work for the National Health Service but more accurately I work for the National Illness Service. We’re good at treating stuff but we’re not good at preventing it – mainly because most people like the freedom to make their own mistakes and object to doctors and politicians telling them how to live their lives. And we are particularly bad at screening diseases. Breast cancer screening simply doesn’t work but we still pour millions into it in spite of evidence to the contrary; bowel cancer screening may be starting to have some benefit but sending your poo in the post and then having a colonoscopy is not popular with patients and existing bowel services are being drowned by the extra a screening work; prostate cancer screening doesn’t work and thankfully the NHS has wasted any money.
Ideally we want to be able to screen for the real killer cancers early – lung, pancreas and ovary. But presently we have no effective screening tool. So imagine my amazement when these guys from Freenome are claiming they can deliver the holy grail of health care screening. The ability to screen for all cancers with a simple blood test years before conventional tests can find anything!!! This was mind blowing.
But I’m the ultimate sceptic, if something is too good to be true then you can be pretty sure it is indeed too good to be true. However the science behind Freenome is very compelling. Cancer results from damage to your genetic code, DNA. This damaged DNA is shed into your blood stream all the time. The experts at Freenome have developed a system which is able to link these DNA defects to various cancers and the more data they’ve got the better their algorhythm is at predicting whether or not you’re developing cancer. The great promise of this entirely new screening tool is that cancers will be picked up very early indeed offering the potential for a complete cure. So although all this may be too good to be true, even if there’s a slight chance they may be right – from the healthcare perspective it is a complete game changer. It is something we need to support.
I presented their findings to my colleagues at the practice and it just so happened that our present registrar in his previous life was a highly respected mathematician and he knew a couple of the Freenome team. He met up with them at an IT conference in Barcelona last week. We were, somewhat naively, hoping that we could be the Dorset wing of their enterprise offering up our patients as guinea pigs. And would you Adam and Eve it!! Freenome started off looking to the NHS for help and support.
Now forgive me for not understanding, but if I’m running an institution which is on life support and someone comes along with a potential cure I would do everything possible to develop that cure. However it seems that the NHS smelt a rat and were more worried about breaches in confidentiality (even when the request was for fully anonymised data) and making a profit out of the situation (apparently access to such data costs millions). As usual they missed the bigger picture. The Freenome team, not surprisingly, did not want to waste millions of pounds and years of work and simply jumped ship to the US. Once again the NHS had an opportunity to make a difference and got it woefully wrong.
So, Mr Hunt, I write to you – the head of the NHS – as a GP drowning at the coal face, to see if you could possibly resurrect this particular baby from the bathwater.
Are you able to change the systems which govern how the NHS functions to ensure when exciting developments like this present so that we will grab the opportunity to nurture and support them rather than doing the opposite?