What is to be Done With the NHS?    
    Frank Kimbal Johnson calls for some radical new thinking    
       
   
       
   

The National Health Service is widely regarded as the 'flagship' of the Welfare State; so anyone who raises serious questions about it is apt to be dismissed as a crank or crypto-fascist, especially by those with a vested interest in the dependency culture. The politicians' dilemma is that real improvements in the NHS and the nation's health demand quite radical reforms which would be bitterly opposed by NHS employees exploiting the mass media, popular sentiment, medical soap operas and private fears - all to prevent any worthwhile changes.

Since about 72p in every pound spent on the NHS goes on salaries and wages, there is a very large element of self-interest involved when doctors, nurses and their supporting staffs are constantly clamouring for a bigger NHS budget. Yet the precise relationship between increases in the NHS budget and measurable improvements in public health or treatment outcomes is never allowed to enter the debate; any questions of that nature are dismissed as bureaucratic interference. The doctors and politicians know only too well where they stand in the hierarchy of public esteem.

Even so, recent widely publicised failures and some scandalous incidents have generated a lot of public disquiet and scepticism which politicians and the 'caring' professions can no longer afford to ignore. In particular, the notion that doctors should be left to regulate themselves has been severely jolted by the notorious Shipman case and by public exposures of surgical incompetence. Note for example that, in the Shipman case, no-one saw fit to mention that the two doctors who sign a cremation certificate are paid £41 each; but then most hard-working people would be shocked to discover the scale of extra emoluments received by GPs and consultants for relatively trifling tasks. Remember always that when asked how he finally persuaded the doctors to accept his NHS Bill, Aneurin Bevan said: "I just stuffed their mouths with gold."

Main needs of reform

Serious NHS reform demands a combination of epidemiology (the study of the incidence of diseases in populations), cost-benefit analysis, reliable independent research into treatment outcomes, radical reform of medical education and training, and the diverting of a far greater proportion of the NHS budget to health promotion and disease prevention.

So it is absurdly na´ve to believe that dazzling demonstrations of surgical technology in TV programmes signify that the only things wrong with the NHS are bureaucracy and lack of money. And besides, there is compelling evidence of a great deal of unnecessary surgery and superfluous clinical tests, all of which comes with a staggering price-tag.

The much-vaunted 'clinical freedom' of prescribers also lands the taxpayer with a drugs bill exceeding £3 billion a year, and the few timorous attempts to control this expenditure have been effectively thwarted by a combination of medical politics and commercial lobbying.

In addition to rigorous examination of NHS cost-effectiveness, organisation and the 'caring' professions, there must also be a sensible reappraisal of the precise conditions which the NHS should be expected to treat at public expense. These should certainly exclude things like alcoholism, drug-addiction, smoking-related illnesses, obesity, HIV/ AIDS (treatment costing over £30,000 per case per year), venereal diseases, infertility in women over 35, self-inflicted injuries and elective abortions. After all, what insurance company would provide comprehensive cover for a person with an obviously reckless lifestyle - except at a premium no-one but the very rich could afford?

All sentiment aside, disease and treatment are the livelihood of the 'caring' professions and treatment industry; but maintaining a healthy lifestyle is the primary duty of every individual, and this has to be a founding principle of any so-called National Health Service.

Those feckless individuals who wittingly expose themselves to avoidable disease and injury simply should not expect more sensible people to pick up the bills for treating them; they should therefore look to private health insurance or charitable bodies.

But the most formidable problem facing any NHS reformer will always be the deeply entrenched self-interest of the medical profession, whose members - for all their protestations about bureaucracy and their claim to professional dedication - enjoy a freedom of action unknown to any other group supposedly serving the public interest. The extent to which this freedom is being abused has for far too long been concealed by medical soap-operas, slick professional PR and the natural reluctance of politicians to be seen interfering with the sacrosanct doctor-patient relationship. But the chronic diseases of the NHS will not respond to the political equivalent of aspirins, tranquillisers and sticking-plasters.

To begin with, we really must challenge the preposterous over-training of doctors who, after some seven years of such training in general medicine and elementary surgery, may choose to specialise for the rest of their working lives in fields where most of this training will never be called upon. For example, who needs seven years of such training to become a psychiatrist, anaesthetist, ophthalmologist, obstetrician or dermatologist? And remember that, according to recent research, at least seven out of ten patients seeing GPs could be adequately diagnosed and treated by a mature registered nurse, given easy recourse to a medical second opinion. In the former Soviet Union - and this may still be the case in present-day Russia - a medical technician performed more cataract-removal operations in a single day than any consultant ophthalmologist in Britain does in a month; and note that we have long waiting lists for such operations in the NHS. So keep in mind the anecdote about the weary old lady who said to the white-coated experts surrounding her hospital bed: "But are you really doing all this for me or am I doing it for you?"

In relation to each category of illness or injury we must therefore establish a particular form of education and training; and this alone can eliminate most, if not all, of the waiting-list problems we hear so much about. At the same time, it would avoid the quite absurd and scandalous over-reliance on immigrant doctors - a situation for which the General Medical Council is entirely culpable.

Replacing the treatment industry

The long and short of all this is that we have to replace the present treatment industry with a genuine National Health Service built on individual self-reliance, wholesome lifestyles, adequate public health and hygiene arrangements, environmental protection and promotion of good health as a citizen's first duty. We simply cannot allow ignorance, mawkish sentiment, professional self-interest, disinformation, commercial interests and political cowardice to undermine the nation's health, and bankrupt its economy in the process.

And the undoubted fact that many NHS staff do a first-class job does not alter the need for radical reform of diagnostic and treatment services; indeed, such reform would enhance these people's skills, improve their morale and remove many serious impediments to their work.

A nationalist movement like the BNP is dedicated to the survival and betterment of our race and nation, so it must take all necessary measures to improve both public and personal health, however strenuously opposed by certain groups who put self-interest above honour and public duty. This does not make us less compassionate than our political opponents, but altogether more honestly and sensibly devoted to improving the lot of our kinfolk.

The writer of this article, Frank Kimbal Johnson, is a retired NHS management consultant with unrivalled experience in the organisation and management of regional and local health services.

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