Page 8, 6th July 1990

6th July 1990
Page 8
Page 8, 6th July 1990 — Money is not the language of health
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Money is not the language of health

The NHS bill, nearing the end of its Parliamentary passage, is mistaken in other ways too, argues GP Dr Dorothy Logie.

FOR the third time this year, Jeannie was admitted to a Glasgow hospital with

pneumonia. Now she had to be extensively investigated for the cause. Could she have some rare defect in her immune system?

Nothing was found. So, hundreds of pounds of investigations later, she was returned home. A friend of mine, an interested doctor, decided to visit her at home.

Eventually she found Jeannie in one of Glasgow's worst slums, scantily-clad, in a room hazy with cigarette smoke. The damp was widespread: water ran down the walls.

Effective treatment of the illness entails consideration of the whole patient in her or her environment. Social, psychological and spiritual problems have a profound effect on health. In my own speciality of general practice, we often see too clearly why our patient is ill: the pneumonia from damp housing: the heart attack from the depression of unemployment: the cancer from the loneliness and shock of bereavement.

It was Carl Jung who asked: "Is the doctor equal to the task? What will he do when he sees that the illness arises from having no love, only sexuality: from having no hope because he (the patient) is disillusioned by the world and by life: from having no understanding because he has failed to read the meaning of his own life?"

The government has recently

Who can afford to keep the inadequate and ill-motivated?

introduced legislation which will radically alter the delivery of health care in this country. A whole new vocabulary has entered the medical world, we are to be the purchasers of "commodities" of health, we are to buy "units of care", hospitals are to "opt-out", practitioners are to "budgethold", while "internal markets" control the pursestrings. It is the jargon of accountants and financiers, looking for value for money. It is restructuring for an "illness service" rather than a health service.

How do you price counselling services or even hospital chaplaincies? How will their "cost-effectiveness" be judged? How do you calculate the treatment of recurring pneumonia due to damp walls?

Competition between hospitals and doctors is the leitmotif that runs through all the thinking. Who will the losers be in this insane accounting game? . .. the poor, who already have more chronic ill health than the rich? General practitioners reaching for "targets" in screening programmes will be penalised

(perhaps by thousands of pounds) for not attaining them through patients who default. Who can afford to keep the inadequate and ill-motivated? Or the Aids patient? Already there are cases of "uneconomic" (or should it be "needy"?) patients being thrown off doctor's lists. General practitioners have now less time to spend with each. The poor, the lonely, the chronically ill and the dying do need time. In this secular world, the sad reality is that we frequently take the place of priest and minister.

As hospitals decide to close uneconomical services, the handicapped and chronically ill may have to travel far from family and friends. For the elderly, private nursing homes will flourish at the expense of charitable and local authority ones. Experience suggests that, in these, the profit motive is paramount and they tend to institutionalise in the most profound way.

In a land boasting Christian values, we must ask ourselves a fundamental question. Is it right that we as a nation spend only 6 per cent of our gross national product on health? (Only Portugal and Greece spend less). The irony is too that we already have a very economical service, spending only 4.5 per cent of our total health care budget on administration: compared with 21 per cent in the USA. And it is this transatlantic model we are rushing into headlong.

Doctors despair as their dissenting voices go unheeded. The National Health Service has been an inspiration to many at home and abroad, founded from the ruins of the war when one hoped for a better future and a more equitable world.

Of course it has its problems and deficiencies. Too little is known about outcomes of care, waiting lists are lengthy, cost comparisons are poor and we are faced with a rising elderly population.

With goodwill and intelligent co-operation between politicians and health carers, these problems could be tackled. But radical reforms are being introduced which are untested, with minimal consultation with either the general public or the medical profession.

Is it not our moral duty to speak out? "For what you do unto one of the least of these . . . you do it unto me."




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