Our three healthcare dogmas

The following article is by Dr Timothy Tomkinson, a doctor currently working in the NHS. 

“The NHS is the closest thing the English have to a religion”, so said Nigel Lawson in a statement which appears more true now than ever before. With topics polarising the country from Brexit to the national parties at large, arguably the most enduring national issue somehow still remains unaddressed.

Whenever we talk about the NHS (which is a rare occurrence), we do so in ideological tones. Generally each discourse involves a small pre-amble about how great the NHS is, swiftly followed by praise for all the hard working doctors and nurses, and then culminates in a banal statement which is either so vague as to be meaningless or so dogmatic as to be grounded in nothing more than pure wishful thinking.

Considering how important the NHS is to our lives, it is something we should spend more time talking about, and which we should be more open about as well.

It strikes me that each discourse is based on a few key dogmas - the Trinity, if you will, of modern healthcare policy: 1) The NHS is a moral force (rather than a way to provide people with healthcare), 2) The false belief that we are the only country in the world to have universal healthcare, and 3) Equality is the most important metric of outcome.

The first point is integral, for as long as we see healthcare as a moral rather than a practical necessity, it will be impossible to discuss openly. Much as with religion, if we are unable to see the negatives in a system, we will be unable to improve them. As long as we see the NHS as totemically moral, we will be unable to see the negatives.

The second point is as fallacious as it is commonly believed. Amongst what I would estimate to be the majority of my medical colleagues there is a tacit, if not explicit, assumption that we are one of, if not the only country to have universal coverage. It is the single biggest lie which prevents open discussion, as it implies we are separate and ‘above’ other countries by this innovation. By realising that almost every European country (with the possible exception of Ireland) has universal free healthcare coverage, it means that our system can be compared to theirs directly and we can no longer justify poor healthcare outcomes on the basis of ours being a uniquely moral system.

The third point is the most contentious, and it is a topic for real discussion. However, the assumption that equality is the most important metric, is a tool used to disguise the fact that our healthcare outcomes are significantly worse than other comparable countries. This bleak reality is true across the board.  The UK has significantly worse outcomes on almost every healthcare metric. For now I will give just one example: the UK has the lowest 5 year survival rates for 4 of 5 cancer types studied, compared to other developed nations - although there are many other examples.

By addressing these three issues we can work towards a discussion which is truly patient-centred, not based on ideology. We can acknowledge that patient care should be at the centre of healthcare policy, rather than moral intent; and in doing-so we can look to other countries for inspiration and innovation to help us achieve this. At a time where people are routinely criticised for being so insular, why are we so reluctant to look abroad for inspiration?

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