As Karol Sikora wades into the debate over rationing health care for the elderly (in his case, specifically the allocation of life extending cancer drugs), it seems that the power brokers in the NHS are once again self-limiting any robust analysis by hiding behind the dogma that the NHS is operating within constrained resources and competing priorities. Which, of course, to a degree is true, but only if the solutions that are presented to the rest of us continue to be rooted in the political status quo.
But first, let’s have a look at the specifics of the argument. It is difficult to counter the view that an elderly individual with multiple life threatening conditions will not benefit greatly from an expensive drug designed to extend life a few months rather than years. This is the example Sikora appears to have given (at least as reported in the weekend press). Although his views provoked criticism this weekend, they coincide with a review by the National Institute for Health and Care Excellence (Nice) of whether to take age into account when deciding whether a drug is prescribed on the NHS. And there-in lies the rub. This isn’t a debate about the odd specific, extreme example that shouldn’t in any way justify a huge generalisation – it’s simply the one form of discrimination that we seem to think it’s still acceptable to propagate without fear of sanction or recrimination. Surely everyone has the right to be treated as an individual rather than a demographic.
In essence, when Sikora (and NICE) talk about “wider societal value” and “further contribution to society” they are (apart from abusing the English language with management jargon) in effect setting themselves up as arbiters of what constitutes added value. Let’s examine “societal contribution”.
- The elderly have, in most cases, contributed through national insurance and taxation all of their working lives. Denying them their right to free care at the point of need is clearly perverse
- Who decides “societal value”? What price a young, healthy habitual criminal against, say, a stay at home mum who hasn’t paid a pound in taxation? Both, one or neither? Or does societal value only apply to those over a certain age who have already made their contribution. Maybe everyone could request an assessment of how much contribution has been made against the extent to which NHS services have been used over their lifetime. We’ll all request our appropriate refunds and watch the NHS spiral further into debt
- Do we all get a say? Maybe we could censure specific individuals on the grounds that they are simply obnoxious. Of course, what the proponents of the debate actually mean by societal value is how much money is likely to find its way into the taxation coffers. Little or no account is taken of the lifetime contribution already made.
There is always merit in debating the value of specific (and yes, expensive) treatment for individual patients. But to deny older cancer patients treatment based on their age alone is unacceptable discrimination. I know the Sikora example didn’t argue on the basis of age alone, but watch that line get redrawn as the debate takes hold.
In the final analysis though, these are surely the wrong questions. If we really want to tackle the NHS funding crisis, we need to stop ducking the fundamental issues that fear of failure at the ballot box prevent most politicians from tackling.
- Making sure that the NHS principle of free care at the point of need is paramount. Stop funding lifestyle choices and prioritise the ill over the politically savvy and the single issue pressure groups.
- Hypothecate (I’ll reprimand myself later, I meant ring-fence) NHS funding and challenge us all to pay more through National Insurance or some form of social insurance (Frank Field, take a bow). Numerous talking heads keep popping up in the media and telling us the NHS is unaffordable (usually, but not exclusively proponents of increased private company involvement in care delivery) without pointing out that our overall health spend is significantly less than much of the developed world.
- Find a way to harness technology to reduce drug costs rather than allow pharmaceutical conglomerates to hold the NHS to ransom
We are an ageing population and technical developments will to allow us to lead longer and hopefully more fulfilling lives. This is the 21st century and the UK is one of the most developed countries in the world and we should have an NHS that reflects that. There is nothing fundamentally wrong with the model of delivery, the travesty is our refusal to bite the bullet around what a 21st century NHS will cost.
And while we’re on a roll, check this out as well!