How do we strike the balance between quantity and quality of life?

HOW does the NHS keep people alive into life’s later stages without compromising their quality of life in the process? That is the dilemma Richard Holloway has touched on, but it is something medical leaders in Scotland are already wrestling with through an agenda known as “realistic medicine”.

Catherine Calderwood, Scotland’s Chief Medical Officer, admitted last year that modern medicine had led to a tendency among doctors to over-treat patients and urged a shift to “more open and honest conversations” about risks and benefits that might see quality, not quantity, of life prioritised.

Speaking as she launched her Realistic Medicine report, Dr Calderwood said: “I think doctors are fixers – they want to help – but I think we have perhaps overestimated the benefits of some treatments and maybe under-estimated the risks and perhaps under-estimated the burden of healthcare – visits to hospital, visits to the GP surgery, blood tests, monitoring.”

No-one would choose to live, as Mr Holloway describes, when their “sole purpose is staying alive” without any pleasure or meaning. But it is a difficult balance to strike without the NHS ending up accused of reducing treatment to cut costs.

The Nuffield Trust has estimated more than two-fifths of national health spending is devoted to people aged over 65, with an 85-year-old man on average costing the NHS about five times more than a man aged 30.

This sort of data can imply the elderly are a drain on resources, which is deeply unfair. It is right they have more say in their care, but Mr Holloway might argue they should also have more control over their death – and that is an even harder balance to strike.