Dame Fiona Caldicott, Honorary Fellow, former Principal and chair of Oxford University Hospitals NHS Trust, writes about our complex relationship with the NHS ahead of a Public Policy Group discussion in London.
We care deeply about the NHS because of its wonderful ethos of being free at the point of use. That removes a huge amount of anxiety for people. Compare this to the US, where you have a concern about what is going to happen if you or a loved one is ill. It’s a worry that flares up whenever there’s talk of being charged to see your GP, for example.
But the NHS has changed a great deal since I started working as a clinical doctor in 1967. The range of treatments is now far greater due to medical advances, and some of these treatments are very expensive. Part of the debate you hear about is, for example, when there is a very sick child who needs expensive radiotherapy and the NHS cannot provide this treatment. Or the question of providing costly treatment for cancer when it only extends a person’s life by a few months.
And then there is demography. Medical science has helped to extend the length of life, as has the fact that this is a wealthy country in which people eat better and are better housed – but longevity raises new questions. What is the quality of life, if you have a parent with dementia who is very paranoid, and this is a source of great distress – if there is no way to improve her life, can you help her have a comfortable death and not treat a chest infection? This raises powerful reactions.
There’s also, for example, the question of helping people to die if they have a condition such as motor neurone disease, and will die by choking or suffocating.
Maintenance of life is not a good in itself, and we should discuss the quality of life.
One of the things I believe about the future of the NHS is that the public has to have much more engagement with that. Should we tell people how much a treatment costs? If people do have a hip replaced, or a pancreas transplant, should they know the cost? My view is that it is helpful for people to be responsible if they know. Do they value it more? For example, those people who are scheduled for an operation at the John Radcliffe Hospital but don’t attend. It may be a way of encouraging the public to think about these questions.
To hear more from Dame Fiona and her fellow panellists Professor Farah Bhatti and Anita Charlesworth please join us at the Oxford & Cambridge Club, 71 Pall Mall, on Wednesday 23rd January at 6.30pm. Click here to book online.