The Things That Need to Be Said

[box]Vinay Mandagere reviews Iain Dale’s “NHS: things that need to be said” [/box]

LBC NHS jacket.inddIt is almost customary to start any healthcare discussion with Nigel Lawson’s quote “the NHS is the nearest thing the English have to a religion”. This institution has become so precious that few dare to unabashedly proclaim its instability, yet Iain Dale provides a fresh and, for the most part, a rational approach to the British healthcare system. Written in a concise, polemic style, Dale delineates his suggestions to improve the NHS and challenge the orthodoxy.

I applaud Dale’s approach to the private sector. During any debate on the state of our healthcare system, the word “privatisation” causes great controversy. Many leap to shouting stock phrases such as “We’ll end up like the USA!” or “It goes against the core principles of the NHS!”. Yet, in most cases, the debate over the increasing use of the private sector in healthcare is unfairly and inadequately discussed. As well as this, the very definition of privatisation is one that causes great confusion. Dale’s argument shows that two in three people said that they would not mind if care was provided by private or public sector, as long as it was free of charge. The King’s Fund states that “who provides the service is less important than the quality and efficiency of the care that is provided”. Proposing greater collaboration between private and public would ensure that patients receive the best quality care and NHS resources (such as empty theatres on the weekends) are utilised. The prevailing orthodoxy against market-based healthcare shows how the NHS can be insular and inward looking, as Germany introduced a wave of privatisation in the 1990s to its success.

Dale’s proposition of a seven-day NHS is one that has been picked up by the government. It is a highly laudable concept. Many senior doctors support seven-day care. A poll of more than 5,500 doctors for showed that 68% believe that patients admitted on the weekends receive poorer care. It may be something that “needs to be said”, it may be something that needs to be implemented, but it currently, is not feasible. The current government plans to follow through with their proposition, yet GPs feel it will be too much strain, and the King’s Fund states that the extra £8 billion will only allow existing services to survive, not the extra services brought by the seven-day NHS programme. It’s easy to say what ought to be said, harder to say what could be done.

It is unfortunate that parts of Dale’s argument are simply not well thought out. Consider his proposition to charge prescriptions for type 2 diabetes patients. The reasoning is that they “bring it on themselves”. Dale says “believe me, I know”. He uses the same logic for drunks turning up to A&E. This argument for charging self-inflicted diseases is highly simplistic. It does not take into account the genetic predisposition to diabetes. It is well known that Afro-Caribbeans and Asians are far more likely to develop type 2 diabetes. Indeed, 60% of the world’s diabetic population are Asian. Even at a lower BMI, they are still more likely to have this condition. As well as that, Dale does not take into account any mental health issues. Despite the fact that he proposes greater parity for mental health (a plea that I wholeheartedly support), his view does not consider those with eating disorders. I was fairly angered by this core argument of “they bring it on themselves”. It’s an assertion that lacks compassion. Who else brings it on themselves? Athletes who break their limbs during training? I have no problem stating that personal responsibility is indeed an important concept when it comes to population health, but this proposition is inconsiderate.

Despite the fact that I find some of his views to be narrow-minded, Iain Dale does what many are scared to do. He writes with no limits. The book is easily-readable, lucid and picks up on genuine, rectifiable issues. He doesn’t state how much he loves the NHS, he doesn’t need to. The fact of the matter is that the NHS is the most emotive political debate. It is difficult to have a non-bias approach to it, yet Dale does it predominantly with factual reasoning and logic. It is a must-read for anyone involved in healthcare.

Vinay is a medical student at the University of Bristol, UK

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