More political healthcare madness

Over the past couple of weeks we have been blessed with two political ‘initiatives’ on healthcare which would tend to confirm my long-held belief that politicians are not only completely ignorant concerning the science which underpins medical practice, but also incapable of logical reasoning. In the interest of political balance, one of these gems comes from the government (well, NHS England, but it’s the same thing), and one from the hapless Ed Milliband.

First, Ed’s stated intention to ensure that investigations on patients believed to have cancer will be completed in seven days. This compares with the current government’s two week waiting target for these patients. It’s not clear which patients he is talking about: if he’s saying that any patient who might have cancer will be dealt with in seven days, then the NHS will grind to a halt, because just about every symptom known to man could be due to cancer, but usually isn’t. The two week waiting target has already skewed priorities, with the result that some clinics have been swamped with patients whose problems are not really urgent, thus increasing the delay for those with genuinely alarming symptoms.

So let’s give Ed the benefit of the doubt, and assume that he’s talking about patients who have been seen and assessed by a GP and referred to the appropriate specialist, and where there’s a genuine concern that they may be suffering from a malignant condition. If he’s saying that their investigations (imaging, biopsy if indicated, blood tests and so on) must be completed in seven days, that’s a more realistic target. But still completely unachievable. Let me concentrate on the imaging aspects (x-rays, scans, ultrasound), because I’m a retired radiologist and know a bit about it. Even if we had enough equipment to push patients through this quickly, the scans still need to be reported by a radiologist. Giles Maskell, the President of the Royal College of Radiologists issued this press release in response to the initiative. He makes the point that the UK has 48 trained radiologists per million population; Germany has 78, and Sweden and France have well over a hundred. Add to that the fact that demand for imaging services has been increasing at 10% per year for as long as most of us can remember, and it’s clear that any attempt to set new targets will need top address the issue of consultant staffing as well as infrastructure, and this cannot happen overnight – and certainly not within the five year time horizon of politicians.

And of course, it would probably be a waste of time anyway. Despite the public impression that cancers rampage through the body, spreading their tentacles deeper into the normal surrounding tissues like a forest fire, the fact is that most tumours develop over a timescale measured in years rather than hours, so chopping a few days off the investigation schedule is unlikely to make any difference to outcome. There are much better ways to spend £750 million in the NHS.

Which brings us to NHS England’s asinine plan to give GPs £55 for every case of dementia they diagnose. I mean, what exactly are they supposed to do with the money that will make diagnosis more likely? Is the suggestion that GPs currently just can’t be arsed to do their job properly, and that a couple of quid in their back pocket will induce them to behave professionally? This is where I begin to despair of the ability of NHS chiefs and their political masters to construct a logical argument. I cannot conceive of any way in which this piddling payment will have any effect on the diagnosis of dementia. Yes, late diagnosis is a problem, but that’s because patients present late, not because GPs are too stupid or lazy to recognise the condition when they see it. The money would be far better spent on public education to increase awareness of the early symptoms and signs of dementia, and improving the support service available to sufferers and their carers. But of course, that wouldn’t be eye-catching enough, and wouldn’t attract any headlines.

Ebola is scary, but much more scary is the intellectual poverty of the political class which produces this sort of crowd-pleasing nonsense.

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