David Wrigley: Like another bad penny?

david_wrigleyWe have just seen another report from a London based “think tank,” suggesting profound changes to the way the NHS works. These reports seem to turn up with annoying regularity and are often not written with any evidence base to support them, but they do seem to promote the views of organisations that donate vast sums of money to them. A few months ago we had Reform suggesting that we should introduce a regular payment for all patients to use the NHSan organisation that receives around a million pounds of funding from the very same insurance firms and private companies who would benefit from a “cash for treatment” healthcare system…

The latest idea can be found in a report from the Centre for Policy Studies (CPS)—a think tank founded by Margaret Thatcher in 1974, now chaired by Lord Saatchi, with CPS council members including David Willets MP, Brooks Newmark MP, John Redwood MP, Oliver Letwin MP, and Tim Montgomerie.

The report is entitled “How much do we use the NHS?” with the Conservative Jesse Norman MP as a co-author. The paper explains the concept of annual healthcare statements, which would take the form of an annual letter sent to each NHS user and would detail the costs of NHS services they had used over the past 12 months.

The NHS was founded in 1948 to provide care, free at the point of use, accessible to all, and available to anyone who felt they were unwell. Many of my patients are elderly and use the NHS a great deal—as they should, given their comorbidities. I was therefore shocked to read a quote used within the CPS report stating “a massive share of (NHS) costs go to the final months of elderly patients’ lives, often without real advantage.”

Such papers can usually be dismissed as ill informed ideology, but the worrying aspect is that reports from these think tanks gain traction and are often debated and discussed by the media and given far more credence than they deserve. Well funded London based think tanks often have the ability to lobby journalists, politicians, and policy makers and can garner huge publicity and curry much favour—often to the pleasure of their deep pocketed donors.

I challenged Jesse Norman about his idea on Twitter, and he suggested it needed “careful implementation,”  seemingly trying to backtrack from his report as he was finding there was quite a backlash from online doctors opposed to his ideas about annualised NHS statements. There has been no evidence to support such an idea, and yet many are discussing it as an option.

I am a GP with 1200 patients—most of whom I know very well—and this proposal really grates with me. I know that my elderly patients when they see me say, “I’m sorry to trouble you doctor” or “I didn’t want to bother you the other week about this, but it seems to have got a bit worse now.” I often wish they had attended a little sooner in order for me to treat their illness at the earliest possible opportunity. Imagine, though, if they knew they would be getting an annual financial statement of their usage of NHS resources. I think for many it would fill them with dread and subsequently lead to them seeking less medical advice than they should. Of course this then means their illness may progress further and become harder to treat. It may also mean their illness worsens so much that they need to attend hospital.

The policy may sound superficially a half decent idea, but when it is analysed a little further, and the advice of clinicians with day to day experience of patients is sought, it soon becomes clear that such an idea is only worthy of a brief discussion and then needs discarding into the NHS dustbin of history. I hope this latest idea disappears without trace, but I have a nagging doubt it will be raised in the future by those who seek to introduce fees for NHS care or an insurance based healthcare system.

David Wrigley is a general practitioner in Carnforth, Lancashire.

Competing interests: I am a member of BMA Council and the BMA General Practitioners Committee. I am co-author of the book NHS SOS.