Unintended side effects of healthcare spending decisions

It was a typical morning surgery in the late 1800s that set me thinking. While reading about the life of a GP practising in that era, I noted that he was phenomenally busy – but chiefly in treating conditions that we have now eradicated.

GPs back then must have thought, “if only we could prevent cholera, typhoid, and all the rest, then how much quieter our lives would be.” And we all know what happened next.

GPs today, like the rest of the NHS, are busier than they have ever been, and yet we still share the same wishful thinking about the latest scientific advances.

What’s the endgame?

It feels inevitable that doctors in the next generation will still be as busy as ever, which begs the question as to what we are really trying to achieve? Is there an endgame? If so – what is it? Are there any boundaries to healthcare, or do we keep redefining the abnormal and the acceptable as fast as industries develop new technologies?

And isn’t it inevitable that every medical advance, and every medical policy, has side effects? I’m a great personal example. My dad died of heart disease, 14 years younger than I am now. Through the benefits of modern prevention, I have avoided the condition that killed him, which meant that five years ago I had lived long enough to develop cancer. Dad never had that opportunity.

I’m immensely grateful to the NHS for preventing one condition and treating another, and hopefully I will live long enough to collect a few more. That’s how modern medicine has such an extraordinary impact, and why we are unlikely to reach a time when workload lessens, and demand drops.

Why is it sometimes deemed unethical to deprive people of expensive therapies, but perfectly acceptable to deprive them of continuity of care?

Issues like multimorbidity are an inevitable side-effect of medical success, and yet we under-invest in the generalist services that would best address the issue. Was that a deliberate decision, or the side effect of alternative aspirations?

What are we really trying to achieve? Why do we focus on the priorities that we do? Why are we happy to spend vast sums on some conditions, while almost ignoring others? Did society decide how much palliative care needed to depend on charity shops for support? Or was this another side effect of some distant prioritisation decision whose impact was never quite thought through?

Can’t go on as we are

Why is it sometimes deemed unethical to deprive people of expensive therapies, but perfectly acceptable to deprive them of continuity of care? We know the benefits of quality relationships in healthcare can exceed those of many drugs, but we invest in one – and not the other. Why?

Writing ‘Side Effects. How our healthcare lost its way, and how we fix it’ gave me the opportunity to ask some of these questions and try and unpick the thinking and policies that have got the NHS into its current challenging situation.

I have been delighted with the response – having one’s book chosen as the book of the week by the Observer, and seeing it described as “Brilliant” is great for an author’s vanity – but the next steps are all important. Covid-19 reminded us just how central health and healthcare are to all our lives. We can’t go on as we are.