There’s a discussion to be had about NHS waiting lists, but this is a message that “makes me uncomfortable” says Dave Duffy.
Recently, an NHS consultant caused something of a stir when she suggested patients should “beg, borrow or steal” to pay for private treatment because the health service is “on the brink of disaster”.
It’s not as if patients aren’t aware of the state of NHS waiting lists post-pandemic. It’s the main reason that we’ve seen a steep rise in patients self-paying for their knee surgery, a trend seen by knee surgeons across the UK. The reality remains that, if you’re on an NHS waiting list for knee replacement surgery, you may be waiting a long time. If you take the private route, you won’t.
But “beg, borrow or steal” is a message that makes me uncomfortable. It creates the wrong narrative, injecting a level of panic and fear that can distort the discussion. I fully accept that if you’re in pain and waiting for an operation it’s an extremely difficult time and an extremely emotional subject, but your cause isn’t helped by this sort of alarmist statement.
Private surgery, if you are insured or can afford to pay for it, is an option that’s open to you. But what about those who couldn’t afford it no matter how much they ‘begged, borrowed or stole’? We need to find a solution within the NHS too.
Grown up conversations
I’ve discussed this before in these pages. There is certainly a grown-up conversation to be had about waiting lists, urgent and non-urgent treatment and our priorities as a health service and as a country. There are a lot of people to treat and, no matter how much money you throw at it, there’ll never be quite enough to cover all the specialties you’d want to include, from cancer to cardiac, stroke to fertility treatment to paediatrics.
So, just as you would with your own household budget, you prioritise. In crude terms, you favour the treatments that deliver greatest bang for your buck, and which deliver greatest quality of life. It’s why we might see a cancer treatment that offers five years of extended life expectancy favoured over one that offers three additional months. At a purely logical level, that’s a fairly easy decision to make. It gets much harder when you’re weighing the relative merits of that cancer treatment against a knee replacement that could transform the quality of life for a patient for the next 15 years. That’s why we have a standardized system which tries to bring a rigour and consistency to such decisions.
Even so, the budget is limited. So we do need to look again at how we fund non-life-threatening procedures. Whenever someone suggests such a thing, the fear is that it’s the thin edge of a wedge that leads to an erosion of service provision and a rowing back from the principles on which the NHS was founded. If you whittle away at it too much, then by the end there’ll be nothing left.
Building up not breaking down
I suggest a different approach – one that involves building up from scratch rather than trimming the ‘fat’. We don’t whittle away; we press reset. We reengineer an NHS that, when our life is in danger, will deliver the highest possible level of care free to all at the point of use.
Beyond that, we build up in a stepwise fashion, looking with fresh eyes at who we treat and what we treat them for. For some services and some people, that may mean taking a new approach, such as that adopted by the Australian healthcare system.
In other cases, new, relatively inexpensive treatments which don’t meet the ‘bang for buck’ mass application requirement of the NHS might still benefit some individuals. Availability through private routes could help reduce waiting list pressure elsewhere.
In combination, these approaches could help ensure that everyone gets better, faster access to the healthcare they need – free from the need for anyone to beg, borrow or steal.
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