Liam Farrell: The options may suck, but the NHS can't go on this way

Some day in the future, historians will look back at the NHS and say there was a time, in the twentieth century, when people actually gave a damn about each other.

But it can’t go on this way, the NHS can’t do everything for everyone. As medical science progresses and our population ages, the health service is like a budget airline trying to cram larger and larger pieces of luggage into a small overhead locker which resolutely remains the same size.

Caring for everyone and everything is a noble aspiration; but as Mosca says in Volpone: ‘This hope is such a bait/It covers any hook’.

We live in an imperfect world and it’s this very aspiration that undermines us; as in so many things, perfect is the enemy of good, and trying to do everything for everybody hamstrings our endeavour to do some good for most.

The big problem with the National Health Service is not sick people, but well people. What is never understood, by patients, the general public, the media, bureaucrats, managers or politicians, is the huge numbers of people family doctors see who aren’t sick, and who have nothing wrong with them; this really can’t be comprehended unless you sit in with a family doctor for a whole surgery.

A huge part of our job is telling people what they don’t have.

Unfortunately, ‘nothing wrong with you’ is a retrospective diagnosis and can only be made after the consultation. As the threshold for attending healthcare services grows ever lower, there are more and more worried well, too much screening and over-treatment and consequently not enough time and resources for the really sick; so everyone loses.

Patients have responsibilities as well as rights; we know this because we’ll all be patients someday, if we aren’t already.

Call it rationing, call it prioritising, it will need decisions made amid diverse opinions, balancing valid but competing ideas and interests. We’ll be leaving some people out, but it’s the right thing to do, or as so often in medicine, the least wrong thing. The options might suck, but they’re still our only options.

The NHS has done great service, but as Tancredi reminds us in The Leopard: ‘If we want things to stay as they are, things will have to change’.

  • Dr Farrell is a GP from County Armagh. Follow him on Twitter @drlfarrell

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