Earlier this week, the new NICE guidelines on investigating patients with possible cancers made the headlines. There was much talk of speeding up investigations, and making more tests directly available to GPs, without prior referral to hospital specialists.
This was all necessary, we were told, because our cancer outcomes lagged behind those of mainland Europe, and this was largely due to delays in diagnosis.
The politicians were on the bandwagon, of course, claiming this initiative as another indicator of their commitment to improving the NHS. And yet again, we were all left wondering what planet these people (not just the politicos, but the medically qualified proponents of the changes, who should know better) are living on. Let’s take just one of the quotes from this report. It’s not clear from the article just who said this, but someone did:
The guidance has ‘modest’ cost implications for primary care, he said. Initially, specialists may see a rise in referrals, but as direct access testing becomes more widely available, the ‘overall cost will be smaller than expected and the benefits greater than expected’.
Well, of course the cost implications for general practice are modest – all the GP has to do is send in an electronic request for (e.g.) a CT or MR scan. The costs will be borne by the hospital departments called upon to carry out the scans, the endoscopies and pathology tests.
I’ll concentrate on imaging tests, because that’s something I know a bit about. Demand on radiology departments has been increasing at around 10% per year for as long as most radiologists can remember. Needless to say, increases in manpower and equipment have not kept pace with demand, and most departments are already struggling to meet their workload commitments.
Since my response to most fuckwittery of this kind is to write to The Times, I fired off a scornful (but thoughtful and beautifully composed) letter. Like most of my attempts, this one did not appear, but they did publish one from Giles Maskell, President of the RCR, making pretty much the same the same points about resourcing.
And going back to the quote above; that bit about costs being smaller and benefits greater than expected as testing becomes more widely available – did that ring the same bells for you, as it did for me? Yes, that’s right, it’s dear old Nye Bevan again, telling us that once the NHS was up and running, everyone would be healthier, demand would reduce and costs would come down.
Well, we all know how Nye’s prediction worked out, and it’s the same with increased imaging rates. Yes, a few more cancers will be picked up, but so will a whole load of other anatomical bits and bobs and normal variants which need further investigation before being written off as inconsequential.
We know this, because we’ve seen what happens when patients are enticed by the unscrupulous private ‘health MOT’ factories springing up on our high streets. Patients turn up at their GP surgeries clutching unhelpful, nearly but not quite normal CT reports which invariably suggest further imaging or other testing, thus piling costs on to the NHS (it also, of course, consumes the GP’s time, so actually, the GP costs may not be as ‘modest’ as the scheme’s apologists suppose).
I suspect I can predict how this will turn out in practice. Radiology departments will crumple under the strain, not only increasing waiting lists for cancer patients, but even more so for those with less newsworthy ailments that have not felt the benefits of government initiatives and a barrage of mawkish, emotionally-manipulative TV advertising campaigns1. Belatedly, the politicians will realize that the RCR et al were not crying wolf, and that more imaging resource is needed. That will not be provided by allowing NHS departments to increase staffing and sweat their capital assets, but by diverting the NHS cash which would allow them to do that into the already bulging back pockets of Alliance Medical and the rest of Dave’s mates in the private health sector.
This will, of course, be presented by the government as another example of the private sector bailing out a ‘failing’ NHS.
But the most irritating aspect of all of this is that it provides yet another example of the belief of politicians and, sadly, our professional leaders, that simply saying that something should happen is the same as making it happen. The politicians don’t even have the excuse of an impending election, when everyone expects them to lie and make unrealistic promises.
They have a majority now – a bit of honesty is surely not too much to ask?
- A little footnote for our friends in the media: cancer is not one disease, but many, and so talk of ‘beating cancer’ is nonsense. Also, cancer is not the only, and in many cases, not even the worst disease that we are subject to. Surprising for you I know, but true.