Focus on standards instead of marching

The NHS has been good for doctors, but not so good for patients

The 70th anniversary of the NHS has provoked an outpouring of pieties from politicians of all parties and familiar calls for higher government spending. The British Medical Association appealed to its members to join a march to Downing Street last weekend to protest about privatisation, funding freezes, staffing and pay levels. The BMA’S slogan, “Standing Together for the NHS”, seemed a bit cheeky for an organisation that stood firmly against the NHS in 1948 and for years later.

As things have turned out, the NHS has been good for doctors, but not so good for patients, especially if they are elderly, have learning disabilities or severe mental illness. The scandal over excessive opiate prescribing at Gosport War Memorial Hospital joins a long list of similar exposures of poor standards resulting in death or serious injury to patients, including facilities at Mid Staffs, Winterbourne View, Southern Health and Morecambe Bay.

In 1948, health minister Aneurin Bevan notoriously bought off the consultants by “stuffing their mouths with gold”, introducing a system of “merit awards” that substantially remains in place. In 2004, Tony Blair’s government guaranteed its popularity among GPS when it negotiated a generous new contract. This included an incentive scheme to encourage doctors to prescribe a lengthening list of drugs to a growing number of patients (resulting from lowering thresholds for the diagnosis of high blood pressure, diabetes and other conditions). The so-called Quality and Outcomes Framework cost £30billion, of which half went directly into GPS’ pockets.

An official review of QOF a decade later revealed that this scheme had achieved none of its objectives. It was “not associated with significant changes in mortality for the diseases targeted by the programme”. Some critics suggest that the adverse effects of some of these drugs may even have reduced the life expectancy of elderly patients. QOF did not reduce hospital referrals or admissions and it did not reduce social inequalities in health. The scheme was abandoned in Scotland, yet it remains in place in England.

Instead of marching around London demanding more funds, doctors’ leaders might be better employed considering ways in which the NHS might celebrate its 70th anniversary by providing better value for money and higher standards for all its patients.

Demand for therapy

Within days of the decision by the World Health Organisation to label “gaming disorder” as a mental health condition, the first Nhs-funded clinic for the treatment of internet addiction is opening its doors in north-west London. It seems that the number of young people being diagnosed with some sort of mental illness is expanding to include almost the entire school-age population. Scarcely a week passes without some study discovering epidemic anxiety and depression levels, obsessions and compulsions, autistic-spectrum conditions and attention deficit hyperactivity disorder among the nation’s children.

Given this inflation of mental disorder, it is no surprise to hear from the Association of Child Psychotherapists that there is a “serious and worsening crisis” in terms of the resources required to meet the burgeoning demand for therapy. Perhaps one way to alleviate this crisis would be to restrict the scope of diagnosis – and hence the need for treatment – to children with serious psychiatric problems. Modern malaise: the first Nhs-funded clinic for gaming addiction is to open

Evidence matters

To Westminster, for Evidence Week, hosted by the charity Sense About Science, of which (full disclosure…) I am a trustee. This was a series of events designed to help parliamentarians, in the era of fake news and rampant pseudoscience, to sort out what is reliable and what is misleading in terms of the evidence used to guide public policy.

The aim was to bring MPS together with communities from all over the UK, representing everything from football to wetlands, inner-city housing to autism, fertility treatment to journalism, beekeeping to small businesses, to explain why evidence matters to people’s lives. They offered briefings, training and introductions to useful resources.

For many individuals concerned with these diverse issues, Evidence Week was their first opportunity to set out the case for reliable evidence before the politicians who decide government policy.

James Le Fanu is away