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Dr Teck Khong: We desperately need a doctor-patient leader, a latter-day Beveridge

Teck_khongDr Teck Khong, Chairman of the Leicestershire Health Consortium and Director of Chirurgiae LLP, believes that the medical profession must defend the ideals of the NHS by being unified in true advocacy of patient welfare.

Working in different parts of the NHS and in various regions of the country over thirty years offers an immensely useful breadth of experience of our evolving health system. The changes have been mixed, but with the advantage of "insider" access to perspectives denied to the public, the overall trend is worrying indeed.

Commercial ethos and retail mentality have become pre-eminent in our health system today, thanks to mismanagement and defective policies. Political flirtations with consumerism over the past decade have resulted in a flurry of public-private betrothals which are now progressing to marriage contracts at an alarming rate and which are leading inexorably to the privatisation of large swathes of the NHS, despite the recent change of premiership.

Various large companies that are linked to the privatisation of the NHS have captivated the attention of the government with the sorts of market efficiencies and profitability only powerful commercial organisations seem able to achieve. By welcoming these big corporations, the government hoped to address the intractable problems of cost containment and inefficiencies. However, that is the basis of the most seriously flawed socio-political dogma of recent times.

Dr_teck_2The NHS is an institution founded to care for the ill, the disabled and the handicapped. Patients attend doctors and nurses for advice, treatment and care; they do not buy fixed off-the-shelf products. On the other hand, the likes of Tesco, Asda and Sainsbury sell for profit produce and products based on consumer choice. There are really no choices when it comes to seeking treatment for ill-health. Who would want second best or even third rate treatment when it came to the crunch? 

In fact, in the drive to model our healthcare on commercial businesses, the administration of the NHS has grown enormously to manage the introduction of a market economy in which, ironically, the patient becomes the commodity that is transacted. 

This therefore is the political reality – the profoundly inexplicable tendency to adopt the US market-based model of healthcare delivery despite serious failures in the American healthcare system. Privatisation of publicly funded health systems only creates opportunities for profit-maximising commercial businesses that avoid the unprofitable but significant areas of medical need and long-term complex care. 

Associated with privatisation is fragmentation and narrowing of clinical remits, which have resulted in duplicity of management, addition to costs and damage to quality. Nowadays, instead of propagating the breed of broadly experienced clinicians charged with the wisdom and authority to do the best for those who are ill, we killed them off and substituted them with triage management based on protocols and pathways that stultify the medical intellectual capacity for holistic assessment and care. Healthcare assistants, health visitors, nurses, nurse practitioners, matrons, GPs, GPs with special interests, consultants and defined-field specialists populate an increasingly disjointed system of healthcare delivery with their partial and narrow-field knowledge of medicine. 

So, given that privatisation heightens health and social inequalities with the inescapable conclusion of greater costs and overall inferior quality of care, what needs to be done to stem the decline of care and compassion in the ethos of the NHS in the face of the burgeoning difficulties? 

Quite simply, the distortion of the tripartite compact between the patients, the government and the medical profession that underpinned the NHS needs to be repaired. The medical profession is in desperate need of leadership not only in matters such as training and direction but also in galvanising whole-hearted participation of its members in re-incarnating the original ideals of the NHS for the present socio-economic conditions, cognisant of the advances in medical science. Doctors must, and they will have to, get their profession into order without external interference and further denigration. A future government, in its stewardship, must not commoditise patients and their needs. Instead, it must establish priorities in healthcare and offer adequate funding, but at the same time genuinely devolve and promote autonomous arrangements between the patients and their doctors. 

This proposition becomes even more compelling with additional and significant advantages. Exploitative health tourists who have become a major conundrum will be countered, while our benefits system will be fairer and less prone to abuse as it becomes more transparent to the public and as community responsibility for healthcare is enhanced.

There is urgency and merit in implementing this integrated solution as its window of opportunity closes with the rising tide of commercialisation and privatisation. The future resultant picture of healthcare as dictated by the confusion and unaccountability of the present flawed policies does not bear thinking. 

Does any, any, political party have the courage and the vision to commission a latter-day Beveridge, or does our country have to contend with piecemeal changes that offer merely more of the same in a downward spiral?


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