Assisted Suicide - Right or Wrong?

Recently in British news, and across the world, the argument over whether terminally ill patients are allowed to request assisted suicide, that is the administering of drugs to end their own life. This has been supported by Lord Falconer’s bill which proposes that doctors should be allowed to prescribe a dose of medicine that will end a terminally ill person’s life (a person who is judged by two clinicians to have less than six months to live). The debate occurs in government tomorrow and more than 130 peers have put their name down to speak. I apologise for the length of this post but the arguments are complex and depend on many things. Skip to the section you want to read.

Schools of Thought

This raises the question: how should we decide on matters of life such as this? I will briefly here consider two schools of ethical thought, although there are many others, skip this and the next paragraph if you wish to hear the main issues involved in the debate. Utilitarianism is the belief that we should do whatever brings the widest good and the smallest harm. This considers the intensity of pain and how long the pain lasts. This pain is not only direct pain but also includes a loss of dignity (described as “purity”). The number of people influenced by an action is then considered and the richness of a life is considered i.e. whether an individual life would lead to other pleasures. Finally, universalism considers the certainty that a cure will be found in time. When we consider this school of thought we can address the issue of assisted suicide (effectively active euthanasia) in a systematic way. First the pain. The pain may be great and may last for significant amount of time as a terminally ill person may not be able to control their body and may suffer as a result, this suffering may then be prolonged as their death may be gradual and may be characterised by the gradual shut down of organs. Thus, in contrast, assisted suicide would lead to “pain” in the fact that the body is directly dying yet wouldn’t offer physical pain that could be monitored by the patient, this “pain” is also quicker. Furthermore, dignity may be dramatically reduced if a terminally ill person is kept alive against their wishes, this is because they may not be able to perform basic tasks. Alternatively, assisted suicide could also reduce dignity because it is viewed by some to be “admitting defeat” therefore by committing suicide of any kind it is a rejection of your identity as a human and so may undermine dignity. Furthermore, the extent of introducing active euthanasia for the terminally ill would be undoubtedly great and whether this is beneficial is based on opinions I will discuss later. Finally the richness of life, this is difficult as it is very subjective and does depend on the type of illness and the influence it has over life. For example, an athlete who develops MND will lose control of his body and so this may be viewed as a great loss so the richness of his life, because he gained pleasure from training, would be greatly reduced. In comparison, Stephen Hawking is a scientist and so developing motor neuron disease didn’t affect his ability to ‘write’ books and continue his career so his pleasure was preserved.

Another school of thought is virtue ethics which was developed by Aristotle who believed that the effect on the individual character is more important than the action itself. Thus we should aim for eudaimonia (a type of life that results from perfect balance). This is a form of happiness that is based on patience, temperance and courage which are developed so that we can be happy and so is not in the interest of others. Thus this school of thought doesn’t consider the “extent” as utilitarianism does, but instead looks at the extent as merely a collection of individuals. This school of thought would argue that people suffering from terminal illnesses cannot be ‘happy’ (although this is clearly controversial) and that people should strive to preserve the values of a eudaimonian life. This may mean for example taking courage to end your life, or to have the patience to deal will illness and not resort to assisted suicide. This depends on interpretation.

In Support of Assisted Suicide

Now we come to the main issues and we will first consider the arguments for assisted suicide for the terminally ill. Some people argue that it is a human right to die and that because illness takes away the autonomy of the individual then death is the only autonomous decision left. This argument is particularly supported in that clinical guidelines advise clinicians to act in the interests of the patient and to appreciate each patient’s individual needs. This means that if a patient says they want to die, then this should be respected as opposed to being ignored and forcing the patient into schemes which clearly oppose what the patient wants. For example, a patient suffering from a terminal illness may state they want to die, in response a doctor, under current legalisation, couldn’t offer euthanasia and instead may deal with the problem by increasing support to the patient through nurses and hospices. This, although helping to alleviate the complaints of the patient is acting in precise opposition to what they originally wanted. This creates the image that the healthcare profession is disrespecting to patients and so this may humiliate and frustrate patients. In addition, supporters of the bill may argue that allowing the terminally ill to ask for assisted suicide is the most loving and compassionate response. This was presented by Lord Falconer who stated that his bill would lead to “less suffering not more deaths”.

This would also be viewed as more considerate as Stephen Hawking described current laws preventing the disabled asking for assisted suiced as “discrimination against the disabled to deny them the right to kill themselves that able bodied people have”. This is a particularly strong argument as it suggests that death is an individual choice and thus is a private matter that the individual takes responsibility for. Therefore this implies that only the sufferer can decide and so acting on behalf of the disabled to preserve their life when they do not want it, may be wrong because it undermines their equality and humanity. Furthermore, this argument draws on the inconsistency within society that people are legally able to commit suicide yet those who cannot move for example, do not have access to this law. Thus this discredits arguments against the bill which state that assisted suicide could lead to people being pressured into assisted suicide. This is because, arguably, people are already being restricted in their choice to be able to commit suicide. However, we cannot call this “discrimination” as discrimination is acting on prejudice and so because prejudice isn’t being used (indeed, it is attempting to act in the best interest of the terminally ill) then it is not discrimination. Instead, it is an issue of consent and practicality.

Finally, some believe that assisted suicide should be allowed as the end (the relief of suffering) is more important than the means (helping someone to die). Therefore this is based on situation ethics which argues that certain actions are only justified in certain circumstances which are based on personal judgement. Therefore the benefit and damage of the respective end and means depends on a variety of influences. Hence, because situation ethics is very personal then it is very subjective and so cannot be analysed fully.

Against Assisted Suicide

In regards to the views against the bill and assisted suicide the main argument is that it could lead to pressure from family for a person to commit suicide so that the choice doesn’t represent the individual’s personal wishes. This leads to the possibility of coercion and so this undermines the value of the individual and instead makes life disposable and discredits the value of life which is the basis of society (e.g. doctors always help to preserve life, fire fighters do not see the burn marks on a person and think “I’ll leave him to die in the fire” because of them). This view has been mainly presented by Tanni Grey-Thompson who stated that 61% of people in Washington State choose assisted suicide because of family pressure. Thus laws should protect public safety. There are many issues with this argument. Firstly, this figure is likely to be unreliable as for the figure to be true, people committing assisted suicide, quite obviously, would have to be living. Therefore the fact that many living people are saying that they are being forced into death without even identification by a consultant seems quite unlikely. Furthermore, another way of viewing the statistic, although more controversial and robotic, is that because people are choosing death because their family wants them to (and then reporting this, seemingly uncaringly to the media) indicates a lack of self-value: the “I may as well” argument. This is a much more risky argument as I don’t know whether the 61% of people were crying out for help or simply regarding it as a factor in their decision. Adding to this, however, there may be pressure from the NHS and assisted suicide risks clinic as viewing patients as potential costs. This is much easier to argue against as doctors are unlikely to suddenly abandon their duty of care and begin viewing patients as merely costs. Furthermore, as the patient has become more empowered in recent years with the formation of regulation and stricter guidelines, doctors may become even more cautious when dealing with active euthanasia as they would be worried about complaints. Hence, the seemingly reckless attitude implied by this argument is very unrealistic. Furthermore, as many people have said, there will be regulations and controls in place to prevent this pressure and so this will mean that any exaggerated pressure from doctors would be even further reduced as two doctors would be needed to verify it. Some here may argue that so is the case with abortion and yet we have widespread abortion anyway. To this statement I would say that in the issue of assisted suicide we would be dealing with clear and tangible lives, as opposed to the life of a foetus which is disputed. In this case no-one can dispute that a person is living and so the regulation would be tighter than abortion.

Another argument is that assisted suicide promotes a risk to the development of palliative (pain-relieving) care as less people use palliative care and so development slows. This again can be easily contradicted by splitting the argument into a list of points (P1-4) and a conclusion:

P1: More people choose euthanasia

P2: Less people depend on palliative care

P3: Less people needing care slows the rate of research

P4: Less research means less palliative care

Conclusion: Introducing euthanasia means less palliative care.

First let me address P2. This is not a sound point as due to a growing population the number of people requiring palliative care may grow. This is further amplified when only those who have a reasonable chance of death in 6 months would be able to claim assisted suicide and even then many still would not. Furthermore, many people choosing euthanasia may have previously depended on palliative care e.g. a person due to die in 12 months may go to a hospice for 6 months and then choose assisted suicide. This would mean that the same if not more people will depend on palliative care in the future. Points 3 and 4 are also not sound as palliative care is a growing area of medicine and a number of hospices are already established – they are unlikely to suddenly close. Adding to this in 2014 “there are 230 nurses specially trained in 82 districts. They are supplemented by clinical officers and even doctors to deliver Palliative care at the 131 facilities that are accredited. We also have 12 stand-alone health centre providing Palliative services” according to Ms Kiwanuka, minister of finance in Uganda. This is compared to the 120 specially trained nurses in 2011 in Uganda. Also, points 3 and 4 confuse the rate of improvement with improvement itself. Although, the rate of improvement may slow, improvement will undoubtedly continue as although research may be scarcer, offering patients the choice will lead to palliative care becoming more willing to offer leading support and care to patients to encourage them to continue living. It will become a ‘competition’.

Finally, some people who are against the bill state that doctors may simply estimate wrongly, an example of which is seen in Stephen Hawking. This, however, is rare and could be tackled by a system which allows patients to make the decision and then doctors affirming it. For example, a patient suffering from a terminal illness may state to a doctor that they would like to die, the doctor could then review the patient and if it is found that they could die in 6 months then assisted suicide could take place so that the patient is not influence by the diagnosis and instead makes the choice based on how they are feeling. In contrast a patient who enjoys life may never mention assisted suicide and so the doctor would not tell them how long they have left. This clearly is dishonest and undermines the right of the individual to information and so this method would have to be modified further.

My Verdict

Overall the issues are complex and depends on whether you believes that we all need rules and certain actions are always wrong or whether it depends and must be resolved by looking to the individual. In discussing the issues above, I believe that people should have the choice to die and assisted suicide should be allowed for the terminally ill but this is my opinion. Regardless of your viewpoint however it is clear that if assisted suicide is allowed, it would make doctors’ jobs a whole lot harder and would intensify the debate even more. If you want to give your opinion, I have created a survey in the top right.

Sources

http://www.bbc.co.uk/news/uk-28342849

http://www.monitor.co.ug/News/National/Palliative-care-services-grow/-/688334/2292138/-/vontslz/-/index.html

http://www.bbc.co.uk/news/uk-28374787

http://www.bbc.co.uk/news/health-28337443

http://www.rsrevision.com/Alevel/ethics/euthanasia/ethics.htm

http://ashkristen.files.wordpress.com/2013/11/assisted-suicide.jpg

http://www.ca-aas.com/img/assisted-suicide.jpg

http://pendletonpanther.files.wordpress.com/2009/11/assisted-suicide.jpg

Can we end AIDS?

According to the latest BBC news, if spending on AIDS increased then there is a possibility that the disease could be ended by 2030. Yet the meaning of this statement is unclear. For example “end” could mean that the disease will be eradicated globally or it could mean that the disease would just be restricted to certain areas so that it would cease being an epidemic and instead become an endemic viral disease. There is further obscurity in the latter definition as the success of “ending” the disease in some areas would depend on the size of the area, the population of the people living in these areas, the lack of development in areas still suffering from AIDS. An example of this would be if AIDS was eliminated in Britain yet the whole continent of Africa still suffered from AIDS and didn’t even have access to palliative care let alone a potential cure if Britain developed it. In this case the declaration of “ending” AIDS in Britain would be still less important when we account for global progress and the suffering of individuals. It is for this reason why I shall consider the former interpretation that we can eradicate AIDS altogether in order to set a clear target to be able to compare our current progress to that needed.

Can it be done?

The figures are initially encouraging as in 2013, there were 38% fewer cases than in 2001 representing a decrease of 1.3 million cases worldwide. This trend, if it continued at a current rate of decreasing by 1.3 million every 12 years would lead us to believe that AIDS could be eradicated in 19.38 years which arrives at an estimate of eradication at the year 2032. However this is likely to be far too optimistic. This is because the rate of decline is not likely to remain constant and instead is likely to plateau. This is because the recent fall in AIDS related cases has primarily been in Western Africa. Therefore as these areas become more developed and AIDS cases fall to a minimum other areas of the world may not improve and so this may mean that, as the rate of the fall is due to development, when development has been reached, the rate of the fall will be less. The graph to the right also appears to suggest that although in some cases HIV is declining in proportion, it is only doing so at a very slow rate and that the actual number of infections is increasing, even if this increase is slowing down. Also we must consider the possible 15 year delay when infected people are unaware they have AIDS. This means that any increase in spending to make people more aware of the dangers of unprotected sex will not be seen until 2029 at a maximum. Thus the effect of increased spending is unlikely to influence the decline of AIDS in order to meet the 2030 “target”. 

Nevertheless, AIDS related deaths have fallen by a fifth in the last past three years and so this shows the rate of development of healthcare as AIDS was first recorded in 1980 and so the proportion of the last three years is 8.8% of the time we have known about AIDS. Thus if deaths have fell by a fifth in this time, this would seem to suggest that medicine has accelerated in regards to treating AIDS. Even so this assumption may not be accurate. For example if deaths decreased by half in the previous from 2008-2011 then this would suggest that medical development is slowing and although deaths are still being reduced, this occurs at a much lower rate. Furthermore, this doesn’t give us any information about the cases of infection or what proportion of people with AIDS survive. In 2011 there were “6280 new diagnoses of HIV in the UK. At the end of 2011 around 96,000 people were living with HIV”. Clearly if none of these 96,000 people died then it would appear a massive success (which it would be) and would seem to suggest that we can deal with AIDS, yet this ignores the fact that these 96,000 people still have AIDS and still may endure a low quality of life. Thus ending AIDS wouldn’t be much closer. Also the UK is more developed than Africa say and so may represent the next stage of development for Africa. Thus, if the UK still suffers from AIDS, then it is unlikely that we will see the complete abolition of AIDS globally if even the developed regions suffer. This is specifically shown in the pie chart in which high income countries still have a portion of the total number of AIDS sufferers, even if this portion is low. Hence, although death rates could show the level of medical treatment and care, it cannot indicate how close we are to eradicating a disease.

However, I must also consider the “trickledown effect” as it can be called, in that improving healthcare (and hence reducing the death rate) also allows development of knowledge. Hence if knowledge develops then we can more easily analyse and develop methods of destroying HIV. In addition, more knowledge of the disease can lead to more effective preventative campaigns which may reduce the infection rate and so this would mean that a reduced death rate could be an indicator that the number of cases of AIDS will decrease. In addition, in the book “Hippocratic oaths”, Raymond Tallis states that increases in life expectancy have not solely been gained through healthcare but also education and nutrition. This may be similar in the battle against AIDS because as poorer regions develop, education is likely to increase and so this will also cause a reducing in the infection rate. Despite these issues, though, the article still states that “there have been more achievements in the past five years than in the preceding 23 years” which suggests that this rate of achievement will continue to increase.

What should be done?

If we are to meet this target then, what should the areas of interest be? Fewer than 40% of HIV sufferers receive antiretroviral therapy, a treatment that is often lifesaving. If we focus on the wider circulation of this treatment then we should focus on getting these countries more independent and not reliant on foreign aid. This is because, whilst foreign aid can allow undeveloped areas to access high quality care, it doesn’t give these countries the flexibility that they need. For example, they may not be easily able to increase production. Also, because AIDS is less of an issue in developed regions then these countries may not produce these drugs on a large enough scale. In addition, drugs companies may exploit the reliance of undeveloped countries on their drugs by charging higher prices.

Another area of importance will be ensuring that a “final push” is made as AIDS becomes less common. This is particularly significant with disease as if complacency is allowed to grow then fewer people will acknowledge the issue which could lead to many people being put at risk without knowing. A similar case has been seen in vaccination which produces a cyclical pattern as people get vaccinated so herd immunity increases causing people to perceive the risk as lower as it is less likely to spread. This lowers the vaccination rate and so can cause mass infection which causes vaccinations to again rise. A similar, although not identical, pattern could be seen if complacency towards AIDS is developed

Drug resistant HIV strains could further complicate the issue as they may slow drug development. Methods of resistance could therefore mean that any cure is limited in the long-term as it is probable that HIV strains may mutate and hence render any treatment less effective than originally planned. This means that medical development will be sure to slow if the virus changes even as slightly as to cause a slight change in the success rate of treatment. However, this is already being tackled as in July 2006, a single-pill, once-a-day AIDS treatment (Atripla) was approved by the FDA which avoided the “cocktail” of drugs that is often used to manage the disease. By avoiding many drugs, this means that regular treatment can be given and so this will ensure that the AIDS virus cannot easily mutate as it will be regularly ‘attacked’ as opposed to previously where it could be given time to mutate and develop resistance to a drug which reduced the success of treatment hence leading to more prevalent HIV strains which increased the rate at which resistance to the other drugs could be achieved.

My Verdict

Ultimately, we could compare this attempt to eradicate AIDS to the eradication of smallpox which, so far is “the only infectious disease of humans, to be eradicated by deliberate intervention”. Hence any attempt to eradicate AIDS will require community effort and global interaction such as the AIDS meeting which recently took place in Australia in 2014. The method used to eradicate small pox was a mixture of focused surveillance to identify the smallpox virus, followed by “ring vaccination” which involved a series of quick vaccinations to increase herd immunity. However this is unlikely to be used in the war against AIDS as infections cannot easily be seen. Furthermore, when two sexual partners suddenly develop AIDS then it can be suggested that one must have breach monogamy. This is unpredictable and so it is difficult to prevent the spread of AIDS if people do not take personal responsibility, compared to small pox when it could easily be predicted when someone may develop symptoms (i.e. relatives may be more at risk). Hence, I don’t believe that the target to defeat AIDS by 2030 is realistic in the present day, but I do believe that we can beat AIDS if we introduce a more coherent and direct plan combining international collaboration in medical research with education programmes to allow “ring” approaches to be made.

Sources

http://www.rosehillnazarene.org/herald/hiv.bmp
http://www.nhs.uk/Livewell/STIs/Pages/HIV.aspx
http://www.wecanendaids.org/
http://www.infoplease.com/ipa/A0106323.html
http://en.wikipedia.org/wiki/Eradication_of_infectious_diseases
http://www.historyofvaccines.org/content/articles/disease-eradication
http://www.newscientist.com/data/images/ns/cms/dn9244/dn9244-1_700.jpg
Raymond Tallis - Hippocratic Oaths

NHS - Not for Sale

According to recent statistics, the NHS in England faces a funding gap within the next two years and this will continue to grow by 2% unless spending doesn’t increase to a suitable level. In this post, I analyse what this could mean for the NHS and whether the NHS could save money.

As the government proposes spending cuts to lower the deficit, the NHS has often been criticised for not meeting targets yet a much graver issue is its growing cost compared to a slowed rise in spending. Indeed, provisional figures for 2013-14 show 66 out of 249 trusts finished the year having overspent, that’s 26.5% of all trusts. As this increases, it places and increasing burden on the government to increase spending or reduce costs. These are two strategies that I will address in this post. However, in order to assess where savings could be made, a detailed look into the structure of the NHS is required.

Structure of the NHS

Every year, the department of health allocate a budget to the NHS, this is a limit with which commissioners can commission hospitals and various healthcare items. The commissioners in the NHS consist of the Clinical Commissioning Groups (CCGs). These are groups which are made up of health care professionals, mainly GPs and nurses, but also some members of the public. Their role is to purchase services in their region and so decide which areas gain the most investment in the NHS. This is the product of the initial idea of the government to give money directly to GPs. The advantage that this has is that it places primary health care in an influential position, with GPs able to coordinate a portion of NHS investment. This is useful because primary health care professionals have a much broader view of the issues faced in society e.g. on average how many people require treatment due to obesity. This means that they can more easily and efficiently allocate resources to services specifically tackling obesity for example. This is more beneficial as it ensures that the amount of spending matches the levels of people diagnosed with an illness. Thus this creates a utilitarian benefit by allowing the majority of people to benefit. Adding to this, because spending also determines space and employment needed, this spending, in effect, has a chain effect as more investment is then needed elsewhere, thus by investing efficiently, it also allows labour to be divided up more efficiently which is advantageous considering that this is the NHS’s biggest cost.

However the issue doesn’t lie within individual parts of the NHS, but in the relation between them. This is evident when we consider other bodies such as the clinical senate. This is a group of specialist advisors which can advise members of the CCG about specific services i.e. how much to invest in a cardiology unit. Even so, the CCG doesn’t have to listen to this. This is the first issue that I have found: the clinical senate doesn’t have any solid influence. Why is this important? It is important because it renders the clinical senate only partly useful whilst the cons of having it (i.e. the drain on clinician’s time, the documents required, reports) are still large considering that they may not even be listened to. Therefore, the first area of change I would propose is to reduce the size of the senate and develop the same function higher up in the structure of the NHS. Although it is still required in part to offer more specific and direct guidance and to increase the efficiency of decisions, it is not so much needed on a local level.

Instead the clinical senate could be similar to NHS England. NHS England, oversees CCGs and is responsible for specialist commissioning so that services on which small numbers of patients rely are widely available and are not thus ignored by CCGs. This creates a greater unity in the NHS and is one of the most essential parts in my view. I believe this because it links CCG’s together and so creates a coordinated healthcare system which is important as it allows for the centralisation of NHS hospitals and specialist services which allow them to develop at a greater rate, increasing efficiency by cutting research costs. This is where the clinical senate ought to be more powerful. Although I don’t know all the details of NHS England, it would be useful to have a system of ‘checks’; an example of this would be if NHS England wanted to commission a cardiology unit in Birmingham specifically for certain patients, then this should be ‘checked’ by the senate and agreed. There are both advantages and disadvantages to this. The benefits would be: more effective allocation of resources in the NHS by ensuring that each area is equally considered and so this avoids long-term costs such as under developed oncology for example; greater interaction between specialisms to create a greater unity in healthcare; a stronger and clearer overseeing body as opposed to the current structure which uses many different bodies which can make it difficult for the public to understand. The disadvantage is mainly that this could lead to slower decision making which could prevent immediate development and action and so would prevent against a sensitive response to an issue. Also it could cost more when disagreements occur and a 3^rd party has to intervene. In light of these issues, it may be better to compromise and give the clinical senate smaller influence yet on a national level. This would mean that this body can still be ignored yet would far less likely to be ignored as nationally they have more influence.

On another note, CCGs could be made equal in power to NHS England, this way NHS England would have to effectively “fight” for resources towards specialist services. This contrasts with the current system where NHS England can spend on these services and then give the remainder of money to CCGs. Even so, this is probably not practical in that it would lead to one large body deciding where money is spent and so this would inevitably reduce efficiency because it would prevent the division of labour.

The final area of the NHS that I would like to mention is the public health section which is mainly comprised of Public Health England (PHE). This takes a broader look at healthcare issues e.g. tackling antibiotic resistance. Local governments can now also establish health and wellbeing boards which combine social and health care. These bodies are more interconnected than the NHS England – CCG relationship and also consists of a Health watch which aims to represent the views of patients. The NHS website says that this is important for the following reasons:

• It increases democratic input

• It strengthens relationships between health and social care

• It encourages integrated commissioning

However, with no direct involvement with CCGs or NHS England, this branch of the NHS is often criticised for not representing the views of patients successfully. Therefore, I believe that it cannot viably occupy this intermediate ground. Instead, this branch of the NHS should be built up or be confined. This would reduce the waste for example of collecting the views of patients which are then ignored. Instead, perhaps the public view could be linked to NHS England which would be more useful as this is the central area of the NHS. However, people generally do not care as much about regional developments and generally favour local developments. Hence, we should focus more on linking CCGs with the public if the public were to become more involved in the NHS. This could be achieved through a cluster structure around CCGs with more boards offering advice to CCGs.

Privatisation

Now we move onto whether the NHS should be privatised. Here I will look at the advantages and then at the disadvantages. The main advantage of privatisation would be the incentive for profit. This would lead to a greater focus on cost-cutting and so this would maximise profit. This would mean that any private investor would focus on increasing efficiency and so this would therefore lower the cost for governments whilst also offering a potentially profitable opportunity to investors. Furthermore, competition would be increased which should lead to the NHS wanting to push its costs down regardless in order to maintain profitability. Even so, this I don’t believe is significant because it may lead to monopolisation which could lead to the owner of the NHS gaining significant barriers of entry to other healthcare providers. This would allow the NHS to charge significantly higher which may distort the value of the service and so this would lead to market failure in which people cannot achieve value for money and so this could lead to exploitation of NHS users. Alternatively, the monopolisation of the NHS could increase the rate of research in some areas because the NHS could focus on a specific area of healthcare and thus allow other firms to develop expertise in other areas. This would lead to specialisation of healthcare and so this would increase the productivity of workers because they would have access to higher quality equipment due to the lack of need for investment in areas which are not profitable. Although this creates the issue of under providence of healthcare, other private firms could then explore these gaps and so this would mean that resources can more efficiently be used.

In contrast, the privatisation of the NHS is not, in my view, a solution as hospitals in remote regions would be at risk of closing down due to the high cost associated with running hospitals in these areas, for little revenue. Hence this would probably lead to the greater centralisation of healthcare which, in my first post, I discussed was not necessarily a suitable policy for healthcare anymore due to our ageing demographic. Also, some healthcare professionals have suggested that it would lead to “dangerous fragmentation of health services”. This is because hospitals may no longer be unified under the goal of providing patient care. This would mean that patient records and other patient specific documents for patients requiring longer term care, or care in different regions, may not be easily transferred and so this means that it could slow the process and create a more disjointed health service which would not offer increases in quality of care. Thus the advantage of greater research would probably be balanced and so is not important. This fragmentation is also significant as it would create wider divisions between primary health care and secondary health care which would reduce our understanding of illness and so lead to conflicts within the medical profession.

Furthermore, the short-term costs associated with privatisation would be immense. Particularly with healthcare as extensive regulatory bodies would be required, health and social boards will be most likely scrapped because they offer no profit importance, hence the overall health of the population may decline in this changeover period. This is important to consider as due to the elaborate structure of the NHS (as previously discussed) any changeover may also create transparency issues and so this would further increase the costs to the government. Nevertheless, these costs would be unlikely to exceed current costs. However the whole reason of privatisation would be to reduce costs and achieve economic growth, therefore any monetary cost associated with the changeover should be scrutinised. Finally, any privatisation or charging for treatment would lead to a system based on wealth, increasing divisions and preventing poorer workers from accessing healthcare. Hence this could have a long-term impact as these are generally the workers who need it the most and so if access is reduced then poorer members of society may suffer disease, resulting in more days off work. It is clear that this would have long-term implications. Thus I don’t believe that privatisation would benefit the NHS and I would recommend against it.

Saving the NHS

If then the NHS should remain at the will of the taxpayer, it is clear changes will need to be made. I have dealt with structural changes yet I haven’t focused yet on what general changes could be made to save money. The graph to the left shows the key areas that could be tackled, despite it being dated. Waiting time targets are among the areas which could be changed. A&E targets could be reduced to pressure doctors and clinicians to treat patients faster and more efficiently which would free up more time and so reduce labour costs which are, as shown by the graph, a specific concern. However this is not practical in that we are already struggling with waiting times and any further pressure may not have any effect on reality but instead may only lower the quality of healthcare and also portray the NHS as even further away from its ‘targets’ which would create a negative public view.

Alternatively, the NHS could reduce its recruiting costs by minimising the number of organisations and integrating some organisations so that separate premises are not required. This could similarly be achieved by merging some jobs together e.g. allowing data analysts to perform another job as well. This would be beneficial as due to the large size of the NHS workforce, if each worker did more hours, then this would account for masses of gained productivity time for a relatively little sacrifice by individuals. In addition, cutting management staff would help to minimise labour costs by reducing the need for unnecessary directors. Hence this would allow the NHS to continue to function whilst avoiding an opportunity cost. However, this is very much an older policy and in the new NHS structure there are fewer managerial positions and so any cutting would be unlikely to have a significant effect. Instead the quality of mangers should be raised. This could be achieved by employing economists within the NHS which would allow a more efficiency based approach to health care and may offer another perspective. Whilst this is not likely to solve the ever growing costs (mainly because these are caused by longer lifespans and health needs), it may slow the rate at which they rise, allowing spending to “keep up”.

Another area of concern is NICE which is responsible for introducing clinical guidelines and now has developed a role in social care as well. One way of limiting the growth, and hence costs, of this area of the NHS is to cut guidelines. This would save money yet would likely cause malpractice to rise hence compensating for any saving and also putting patients at risk: a worse situation. Instead guidelines should be simplified and made more encompassing to reflect the needs of patients, whilst also allowing clinicians to understand, act on and be held accountable to these guidelines even though there may be fewer. This simplification is the most viable way of controlling the growing cost of NICE and would offer long-term benefits by allowing clinicians to use judgement as well hence helping to give clinicians flexibility.

Reduction in the cost of medication could also be implemented by increasing medical reviews to ensure that the amount of prescriptions, which are not necessarily needed, are reduced. This would increase the efficiency with which the NHS uses medicines. This is of specific importance as recently in the news, there was a conflict when a drugs company, which wanted to sell a cancer treatment, chose to sell at a high price. This means that by conserving these expensive medicines, important savings could be made.

Finally preventative medicine is probably the most important area where savings could be made. For example, an increase in the power of the PHE would allow more aggressive health promotion which could be combined with taxes and laws. This would increase the awareness of health issues such as diabetes and so would reduce the amount of people diagnosed with these illnesses because people take early prevention methods. Hence this would have a significant benefit and would not be so controversial. This would offer a clear and secure benefit to the NHS and hence limit the amount spent treating these illnesses.

My Verdict

Overall health service productivity has fallen by up to 8% since 1995 and something needs to change. Yet whilst changes are needed, it is vitally important that spending on the NHS increase. Where this money should come from is a mystery yet I would consider cutting areas such as foreign aid. This should suffice until taxes rise in the future as the economy recovers offering more time for change which should firstly be on increasing efficiency as opposed to structural change because any change in structure may undermine confidence in the new NHS.

Sources:

http://www.youtube.com/watch?v=8CSp6HsQVtw

http://helpmeinvestigate.com/health/tag/structure/

http://www.nhs.uk/NHSEngland/thenhs/about/Pages/nhsstructure.aspx

http://news.bbc.co.uk/1/hi/health/4264404.stm

http://news.bbc.co.uk/1/hi/health/3755438.stm

http://www.nuffieldtrust.org.uk/our-work/projects/quest-efficiency-english-nhs