Clap for the NHS, by all means — but don’t be afraid to use it
We all love the NHS, which turned 72 over the weekend. But quite a lot of us, it seems, are also afraid of it. The message that was received by millions of people at the height of the Covid-19 crisis was: help the NHS by not using it. Public health authorities and GPs told their patients not to visit their surgeries and hospitals except in an emergency. The result was predictable: surgeries and hospitals have never been emptier.
Now researchers at Health Data Research UK have told the BBC’s Panorama that up to 35,000 additional cancer patients may die as a result of not seeking treatment, with referrals down by up to 60 per cent. Dr Karol Sikora, the distinguished oncologist, has warned of 50,000 excess deaths from cancer alone. When other illnesses are taken into account, we could be facing a public health crisis no less serious than Covid-19 itself.
The problem is not just that people do not wish to “overburden” the NHS. Many are still terrified of catching coronavirus if they were to visit a health centre or hospital. According to Gary Marlowe, a London GP quoted in the Times: “There is a significant cohort of people who are very worried about coming anywhere near the NHS, because doing so means ‘I’m going to get Covid, and therefore I’m going to get very, very ill’.”
The failure to understand this kind of psychological reaction to the Covid-19 pandemic is already costing lives and will cost many more over the coming months and years — unless the NHS changes course. The biggest problem in diagnosing any illness is always persuading patients to come forward in the first place. For many anxious people, being told to stay at home was reassuring. It meant that doctors were no longer urging them to present themselves to be examined or tested. And since the same anxious people were frightened of what the doctor might tell them, the easiest solution to their health problems was to do nothing. The more serious their symptoms, the greater the fear that a visit to the doctor would bring bad news.
The message put out by the health service, locally and nationally, was bound to exacerbate this vicious circle. This even applies to the ritual of clapping for the NHS. The more that people make a subliminal association of “NHS” with “Covid”, the less likely they are to make the decision to go to the doctor.
It is true that Professor Chris Whitty, the Chief Medical Officer, and his colleagues have for months been urging people not to hold back from seeking help. But this welcome message, that “the NHS is still there for you”, has been much weaker than the deterrent one. The former is clearly still not getting through to many people who ought to be getting treatment.
Those who work in the NHS often fail to realise how intimidating it is for those who don’t. Patients may fear the consequences of “making a fuss”. Thousands, maybe millions, who had their operations cancelled, often at very short notice, as the pandemic took hold, are still waiting for new appointments. The more proactive these patients are, the more likely they are to get ahead in the queue. But a large proportion of patients are passive, even fatalistic, about their predicament. They prefer to suffer in silence rather than pester the powers that be.
The byzantine bureaucracy of the NHS does not help. It is a hierarchical organisation that often seems peculiarly resistant to those it exists to serve. Just now, it is patting itself on the back for not having been “overwhelmed” by Covid-19. Honours and rewards for frontline staff are in the pipeline — and rightly so. Talk to doctors, however, and most are worried. They do not know where the millions of patients with other life-threatening conditions have gone. Time is often a crucial factor in deciding whether a patient recovers or not. This applies not only to the more obvious cases, such as stroke or cancer, but also to mental illness, such as anorexia.
The crisis has shone an often unedifying light on those who live in care homes: many coronavirus victims also have dementia. But getting a diagnosis for dementia is difficult at the best of times, let alone now. The official figure of 800,000 patients living with Alzheimer’s and other forms of dementia almost certainly understates the scale of the problem. Dementia has now overtaken cancer and heart disease as the UK’s biggest killer. The Covid-19 testing programme presents an opportunity to find out just how prevalent in the community dementia really is. Yet the NHS, though desperately short of psychiatrists, enlisted many of them into its Covid campaign — thereby signalling that mental health is still the poor relation.
As a matter of urgency, the Government and the NHS need to rethink their public health messages. If it is safe for people to go to the pub, then it should be safe for them to visit their local surgery. With reasonable precautions, such as washing or sanitising hands and wearing masks, GP consultations and hospital referrals should be normalised again. No doubt consulting doctors over the phone or online will work well for many routine health problems. However, the diagnosis of unsuspected but serious conditions often does require the patient to be physically present. Medicine is an art as well as a science: it cannot be practised successfully unless the physician can deploy his or her entire range of skills and experience.
For months, too many people have been relying not on the NHS, but on “Doctor Google”, to the detriment of their health. The NHS is not free; we pay for it through our taxes. It belongs to us. It is there to be used. The message must now go out, loud and clear: the NHS is safe and it is open for business.
